Skip links

Guide to BPCI advanced bundle payments

How can this model help lower costs and increase patient’s satisfaction?

Bundle payments are not something new to the market – but they are getting increasingly popular and necessary in today’s financial climate. Bundle payments are innovative and can solve many issues associated with healthcare. BPCI Advanced represents a new voluntary episode payment model. It is an exciting program designed to pay for all care associated with a set of specific clinical episodes. Its main use is for 32 clinical episodes with an emphasis on inpatient hospital care for orthopedic and cardiac conditions. BPCI Advanced brings a brand new shift from individual service to coordinated clinical episodes. One of the most important goals of this innovation is simple – it is based on the idea of providing a universal, affordable and accessible healthcare.

bundle payments

Why BPCI advanced is so innovative?

Everything revolves around the patient – the patient is the primary priority. The healthcare system can be very overwhelming. Unexpected bills, confusing codes on statements, and many participants within one inpatient episode acting as separate entities. Bundle payments can change that practice – you have one fixed payment that covers everything. This increases efficiency and better care coordination, all while having better patient outcomes. Furthermore, this will also provide valuable insights to caregivers about how they are using their resources, allowing them a chance to improve operations and processes. Also, data plays a major role – you can easily get lost in the neverending sea of data, even when not every point is essential. This program only focuses on valuable data, such as predicting the length of the inpatient episode and possible outcomes.


What makes this program unique is that it is a voluntary program. Not all hospitals and caregivers are participating in it – yet it has become increasingly popular while bringing innovation to the healthcare system. It is based on one single payment with a 90 days clinical episode duration.

Types of participants

orthopedic bundle

There are two types of participants in this program:


Covener participant is the participant that brings together downstream Episode Initiators (EIs). This type of participant also facilitates coordination, and bears and apportions all financial risks. Covener participants can be eligible entities that are Medicare-enrolled providers or suppliers. Other eligible entities that are in Medicare are Acute Care Hospitals (ACHs) and Physician Group Practices (PGPs).

Non-covener participant is the Episode Initiator (EI) and the most important difference is that the participant bears financial risk only for itself. A non-covener participant does not bear risk on behalf of downstream EIs.

Benefits of CMS BPCI advanced


BPCI Advanced is in many ways different from its older predecessor BPCI.

Some of the major benefits:

  • Encourages both high and low-cost providers to participate
  • Rewards participants’ improvement over time
  • Adjusted for patient case mix that is outside of providers’ control
  • Allows for trends in Clinical Episode spending by hospital peers
  • Promotes Medicare savings while maintaining high-quality care


If you are interested in hearing more about deadlines and participants or you have any questions or concerns about BPCI Advanced model – contact us!