Medicare’s Bundled Payments for Care Improvement Advanced Model (BPCI-A) is a voluntary Alternative Payment Model in which participating hospitals or physician groups are held accountable for the costs and outcomes of ninety-day episodes of care.

In the November 2022 issue of Health Affairs, Karen Joynt Maddox and coauthors assess whether high-risk patients were more likely than non-high-risk patients to suffer adverse selection, increased costs, or worsening clinical outcomes at BPCI-A-participating hospitals compared with comparison hospitals in the first year of BPCI-A.

Despite concerns that Alternative Payment Models may incentivize providers to avoid high-risk patients, Joynt Maddox and coauthors do not find evidence of negative impacts of BPCI-A among Medicare beneficiaries with frailty, those with multimorbidity, or those dually enrolled in Medicare and Medicaid.

"It is reassuring that we did not see increases in readmission or mortality rates or reductions in healthy days at home for high-risk groups, although mortality and healthy days at home should be considered exploratory because they were secondary endpoints," they conclude.

Today on Forefront, US Department of Health and Human Services Secretary Xavier Becerra and coauthors discuss the recently-released HHS Roadmap for Behavioral Health Integration, which addresses the numerous barriers to integrated and equitable access to behavioral health services in the health care system.

David Muhlestein and coauthors provide their annual update on Accountable Care Organization (ACO) growth, writing that they expect continued financial tightening and movement toward downside risk, more incentives for ACOs, and more.

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About Health Affairs

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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