HealthLoop Oncology Care Model
BPCI – Initiative Design

Bundled Payments for Care Improvement Initiative (BPCI)

Physician using computer with HealthLoopThe Bundled Payments for Care Improvement initiative began in August 2011 and is comprised of four broadly-defined models of care that link payments for multiple services beneficiaries during an episode of care to specific metrics achieved or not achieved.

Under the initiative, organizations voluntarily enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality and more coordinated care at a lower cost to Medicare.





Services Included in the Bundle



Model 1

All DRGs; all acute patients


All Part A services paid as part of the MS-DRG payment


Model 2

Selected DRGs; hospital plus post-acute period

All non-hospice Part A and B services during the initial inpatient stay, post-acute period and readmissions


Model 3

Selected DRGs; post-acute period only

All non-hospice Part A and B services during the post-acute period and readmissions


Model 4

Selected DRGs; hospital plus readmissions

All non-hospice Part A and B services (including the hospital and physician) during initial inpatient stay and readmissions



How Many Providers are Participating in a BPCI Model?

As of April 1, 2016 there are 1522 providers participating in a BPCI payment model.













What Types of Providers Participate in BPCI?

The breakdown of participants by provider type is:

Acute Care Hospitals (385), Physician Group Practices (283), Home Health Agencies (99), Inpatient Rehabilitation Facilities (9), Long-Term Care Hospitals (1), and Skilled Nursing Facilities (681). See the COMPLETE LIST of participating BPCI health care facilities.

Coverage Areas

Model 1 Awardees participate in all MS-DRGs. For Models 2, 3 and 4, there are 48 clinical episodes that participants are able to choose from. See the FULL LIST of the clinical episodes of care and their affiliated DRGs under all BPCI models.

Beneficiary Choice

Beneficiaries can always choose to receive care from providers not participating in the BPCI initiative. Beneficiaries retain their full original Medicare benefits. The initiative does not restrict the ability of beneficiaries to access care from any provider.

Evaluation and Monitoring

CMS is actively monitoring the quality of the care beneficiaries receive. CMS is analyzing quality information available from claims and quality reporting from the Awardees, as well as surveys and patient assessment tools to assess the care experience and health outcomes. CMS’ monitoring effort aims to identify quality improvements, including process improvements, changes in outcomes and reductions in expenditures, and to detect inappropriate practices including care stinting, patient selection to maximize financial gain and cost shifting. Participants are required to comply with and participate in Evaluation and Monitoring activities and data collection efforts.

How HealthLoop Can Help

There are 48 clinical care episodes that BPCI initiative participants are able to choose from. With 130+ care plans in its evidence-based, peer-reviewed clinical content library, HealthLoop can readily assist providers in achieving the financial and performance accountability for BPCI episodes of care. These models may lead to higher quality and more coordinated care at a lower cost to Medicare. Automated patient engagement is the next innovation to successfully migrate to a value-based care model. Patients want to engage, you just need to make it easy for them. That’s where HealthLoop’s automated yet empathetic messaging provides the right continuity of care, connecting patients, physicians, hospitals and other post-acute care providers. Here’s how to achieve the greatest outcomes under BPCI with HealthLoop:

Happy Couple using HealthLoop

Meet Your Pre-selected Quality Metrics

HealthLoop identifies patients at-risk for complications and provides help before patients enter an emergency room. HealthLoop’s patient engagement software connects to the care team and helps reduce rates of complications by up to 35%.1

Lower Costs

HealthLoop provides engaging content to help patients comply with care plans throughout the episode of care and achieve the greatest results from their procedure without the need for higher utilization. With HealthLoop’s patient engagement platform, post-acute spending can be reduced. Patients using HealthLoop’s platform are 60%2 more likely to be discharged to home while still receiving the best care possible. HealthLoop’s seamless patient and physician communications ensure continuity of care to mitigate clinical risks before they become readmissions or ER visits.


HealthLoop has a turnkey solution to easily capture and report PROs. Patients respond to PROs with 61% completion at the one year mark without a change to provider workflows or impact on staff time.

Increase Patient Satisfaction

Ninety-one percent of the time, HealthLoop patients are ‘extremely likely to recommend their physician’ to a friend or colleague. This is because HealthLoop’s evidence-based content and automated communications provide the highest level of patient service without the need to invest in additional staff or change workflows. Satisfied patients equal higher compliance and better outcomes. HealthLoop patients feel their care team is empathetic and is virtually with them on their road to recovery. HealthLoop anticipates commonly asked questions and answers them through insightful instruction, reducing calls and frustrating hold times for patients.

Helpful Links

For more information on the CMS BPCI Models, please visit the resources below:

The CMS Bundled Payments for Care Improvement Initiative Models 2-4: Year 1 Evaluation & Monitoring Annual Report, issued in February 2015. DOWNLOAD PDF

The Annual Report 2014 Evaluation and Monitoring of the Bundled Payments for Care Improvement Model 1 Initiative, issued in July 2015. DOWNLOAD PDF

Press Release

Fact Sheet (updated 04/18/2016)

Bundled Payments Learning & Resources Area

Details on the health care facilities and the episodes they will be testing: Participating Facilities

Bundled Payments for Care Improvement – First Evaluation Report Download PDF

BPCI Initiative Episode Analytic File(updated 4/05/2016) Download XLS

General Resources

Model 2 background document Download PDF

Model 3 background document Download PDF

Model 4 background document Download PDF

Part A and Part B exclusion lists Download XLS

BPCI Models 2-4 Discounts Table Download PDF


1 Hip and knee arthroplasty, all ages. Total Joint Registry 1986-1995.Wood, M. Anesthesiology 5 2002, Vol.96, 1140-1146.CA State Discharge Database 1991-3. White, R. et al. Arch Intern Med. 1998; 158(14):15 25-1531. doi:10.1001/archinte.158.14.15

2 Patient-reported, hip and knee arthroplasty, all ages compared to National Hospital Discharge Survey, 2010.