Georgia Medicare BPCI Advanced Bundled Payments Guide 2026

For eight years, BPCI Advanced was the CMS Innovation Center's flagship voluntary bundled payment model and the most widely adopted Advanced APM bundled payment program in Medicare. Formally Bundled Payments for Care Improvement Advanced, it held Georgia hospitals, physician group practices, and conveners accountable for 90 days of Medicare spending against a risk-adjusted Target Price, and it set the stage for the mandatory TEAM model that took effect January 1, 2026.

BPCI Advanced created 90-day clinical episodes spanning dozens of inpatient and outpatient clinical episode categories, holding participating hospitals, physician group practices (PGPs), and conveners accountable for total Medicare Part A and Part B spending during each episode against a risk-adjusted Target Price. For Georgia hospitals and specialty practices that participated after the model launched October 1, 2018, BPCI Advanced was the operational proving ground for episode-based accountable care, and the precursor (alongside CJR) to the mandatory TEAM model that took effect January 1, 2026.

This guide explains how BPCI Advanced worked, who participated, how target prices and reconciliation operated, what BPCI Advanced meant for Georgia beneficiaries and clinicians, and how BPCI Advanced related to the broader CMMI model portfolio and its TEAM successor.

The statutory and regulatory foundation

BPCI Advanced rests on:

• Section 1115A of the Social Security Act (42 U.S.C. § 1315a): the CMS Innovation Center statutory framework, added by ACA Section 3021 (Public Law 111-148, March 23, 2010). BPCI Advanced operated under Section 1115A demonstration authority.
• Section 1833(z) SSA: Advanced APM and Qualifying APM Participant (QP) framework, added by MACRA 2015 (Public Law 114-10, April 16, 2015). BPCI Advanced was structured as an Advanced APM.
• CMMI BPCI Advanced Request for Applications (2018): the original RFA establishing the model.
• BPCI Advanced Participation Agreements: legal contracts between CMS and each participant for each Model Year.

BPCI Advanced was not codified in 42 CFR Part 412, 413, 414, or other generally applicable Medicare regulations. The model operated through CMMI demonstration authority, with details in Participation Agreements and annual implementation guidance.

The BPCI Advanced performance period

BPCI Advanced operated over seven Model Years:

• Model Year 1: October 1, 2018 – December 31, 2018
• Model Year 2: January 1, 2019 – December 31, 2019
• Model Year 3: January 1, 2020 – December 31, 2020
• Model Year 4: January 1, 2021 – December 31, 2021
• Model Year 5: January 1, 2022 – December 31, 2022
• Model Year 6: January 1, 2023 – December 31, 2023
• Model Year 7: January 1, 2024 – December 31, 2025 (extended two-year model year)

BPCI Advanced concluded December 31, 2025, after which the mandatory Transforming Episode Accountability Model (TEAM) took effect January 1, 2026, in selected MSAs.

The 90-day episode structure

Each BPCI Advanced clinical episode was 90 days long, beginning with one of the following triggers:

Anchor inpatient stay (inpatient clinical episode categories)

• The episode began on the date of admission to an inpatient hospital with a qualifying MS-DRG
• The episode included the anchor inpatient stay plus all Medicare Part A and Part B spending through 90 days post-discharge

Anchor outpatient procedure (outpatient clinical episode categories)

• The episode began on the date of a qualifying outpatient procedure (e.g., percutaneous coronary intervention)
• The episode included the anchor procedure plus all Medicare Part A and Part B spending through 90 days post-procedure

Each episode captured everything covered by Medicare Part A and Part B during the 90-day window:

• Anchor hospitalization
• Physician services during anchor admission
• Post-acute care (SNF, IRF, LTCH, home health)
• Readmissions
• Outpatient services (physician, hospital outpatient, lab, imaging, DME)
• Hospice services
• Part B drugs and other covered services

The 90-day window was the critical accountability frame. Participants were accountable for the patient's entire Medicare experience, not just the index hospitalization.

The clinical episode categories

BPCI Advanced covered dozens of inpatient and outpatient clinical episode categories, including the following major bundles:

Major inpatient categories

• Major Joint Replacement of the Lower Extremity (MJRLE): hip and knee replacement (the most-volume bundle)
• Spinal Fusion: cervical, thoracic, lumbar
• Cardiac Valve Procedures: TAVR, surgical valve replacement, valve repair
• Coronary Artery Bypass Graft (CABG)
• Percutaneous Coronary Intervention (PCI), inpatient
• Acute Myocardial Infarction (AMI)
• Congestive Heart Failure (CHF)
• Cardiac Arrhythmia
• COPD, Bronchitis, Asthma
• Pneumonia
• Sepsis
• Stroke (ischemic and hemorrhagic)
• Hip and Femur Procedures Except Major Joint
• Renal Failure
• Gastrointestinal Hemorrhage
• Gastrointestinal Obstruction
• Pancreatitis
• Cellulitis
• Diabetes / Endocrine and Metabolic Disorders
• Cervical Spinal Fusion
• Lumbar Spine Fusion (Except Pelvis)
• Combined Anterior Posterior Spinal Fusion
• Removal of Orthopedic Devices
• Disorders of the Liver Except Malignancy
• Major Cardiovascular Procedures
• Major Bowel Procedure
• Lower Extremity / Humerus Procedure Except Major Joint
• Spinal Fusion (Cervical Spine Fusion)

Outpatient categories

• Percutaneous Coronary Intervention (PCI), outpatient
• Cardiac Defibrillator
• Back & Neck Except Spinal Fusion (outpatient)
• Radiation Therapy

The most operationally significant bundles for Georgia hospitals were MJRLE, CABG, Cardiac Valve, AMI, CHF, COPD, Sepsis, and Stroke. These were high-volume bundles with substantial financial risk and meaningful improvement opportunities.

The Target Price methodology

For each clinical episode category, CMS calculated a Target Price for each participant:

Components

1. Risk-adjusted baseline spending: historical (typically 4-year baseline) average episode spending for that participant adjusted for patient mix
2. Patient case-mix risk adjustment: adjustment for patient demographics, comorbidities, and clinical characteristics
3. Trend factor: annual update for cost trends in the geographic area
4. Discount factor (typically 2-3%): the participant had to beat the baseline by this discount before NPRA savings began; this was CMS's share

The Target Price was the threshold against which actual episode spending was measured during reconciliation. Participants beating the Target Price earned NPRA payments; participants exceeding the Target Price owed NPRA repayments.

Net Payment Reconciliation Amount (NPRA)

The Net Payment Reconciliation Amount (NPRA) was calculated annually by comparing actual episode spending against the Target Price:

• If actual spending < Target Price → participant received an NPRA payment from CMS (positive NPRA, "earned savings")
• If actual spending > Target Price → participant owed an NPRA repayment to CMS (negative NPRA, "owed losses")

NPRA cap

• NPRA was capped at ±20% of the Target Price
• The cap prevented catastrophic gains or losses
• The cap applied symmetrically (savings cap and loss cap)

Quality adjustment

• NPRA was adjusted based on participant performance on episode-specific quality measures
• Higher quality → higher savings or smaller losses
• Lower quality → smaller savings or larger losses

Risk-bearing

• NPRA two-sided risk qualified BPCI Advanced as an Advanced APM under Section 1833(z) SSA

Who participated

BPCI Advanced had three participant types:

Acute Care Hospitals

• Participated as initiators for selected inpatient clinical episode categories
• Hospital-based BPCI Advanced participation was common
• Many Georgia hospitals participated across various clinical episodes

Physician Group Practices (PGPs)

• Participated as initiators (typically for orthopedic, cardiology, or surgical bundles)
• Less common than hospital participation
• Georgia orthopedic and cardiology groups participated in selected bundles

Convener Participants

• Aggregated multiple "Episode Initiators" (hospitals or PGPs) into a single Convener arrangement
• Examples: Remedy Partners (acquired by Signify Health 2020), Cardinal Health, Premier
• Conveners provided analytics, infrastructure, and shared risk
• Many Georgia hospitals participated through Conveners rather than directly

Participation was voluntary, and participants could elect specific clinical episode categories and add/drop categories between Model Years.

Quality measures

BPCI Advanced measured quality on:

Hospital-wide measures

• Risk-Standardized Readmission Rate: 90-day all-cause readmission across the participant's episodes
• Advance Care Planning: frequency of advance care planning conversations
• Perioperative Care Selection of Prophylactic Antibiotic: first or second-generation cephalosporin
• Hospital-Level Risk-Standardized Complication Rate Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA)

Episode-specific measures

• Vary by clinical episode category
• Include measures like AMI-specific mortality, CABG-specific complications, etc.

Quality performance fed into the NPRA calculation as a quality adjustment.

Advanced APM status and the Quality Payment Program

BPCI Advanced was structured as an Advanced APM under Section 1833(z) SSA. It satisfied:

1. CEHRT use: participants used certified electronic health record technology
2. Quality measurement: BPCI Advanced quality measures comparable to MIPS
3. Risk-bearing: meaningful risk via NPRA two-sided risk

Advanced APM status drove QP determination:

• PY 2024+: payment-amount threshold 75%, patient-count threshold 50%
• Partial QP: payment-amount 50%, patient-count 35%

QP benefits:

• PY 2018-2022: 5% APM Incentive Payment (paid PY+2)
• PY 2023: 3.5% APM Incentive Payment
• PY 2024+: Qualifying APM Conversion Factor differential
• MIPS exemption for QPs

Physician participants in BPCI Advanced PGPs or Conveners could achieve QP status if attribution thresholds were met. Hospital-only BPCI Advanced participation did not directly produce QP status for the participating hospital's employed physicians unless physician services flowed through a BPCI Advanced PGP.

Beneficiary attribution and patient experience

BPCI Advanced beneficiaries were claims-based attributed to the participant whose anchor stay or procedure triggered the episode:

• A beneficiary admitted to a BPCI Advanced participating hospital for an MS-DRG covered by that hospital's selected clinical episode categories → automatic 90-day episode
• A beneficiary who underwent a BPCI Advanced PGP's outpatient procedure → automatic 90-day episode

Beneficiaries did not enroll, did not opt in, did not opt out, and may not even have known their episode was included in BPCI Advanced. They retained all Medicare FFS rights: freedom of choice of post-acute care, freedom to see any Medicare provider, no enrollment, no cost, and no benefit changes. BPCI Advanced was operationally invisible to beneficiaries.

Relationship to CJR (mandatory Atlanta MSA model)

The Comprehensive Care for Joint Replacement (CJR) Model was a separate mandatory bundled payment model focused on hip and knee replacement (MS-DRGs 469 and 470, plus knee replacement codes). CJR operated from April 1, 2016 in selected Metropolitan Statistical Areas, including the Atlanta MSA. Like BPCI Advanced, CJR was a precursor to the mandatory TEAM model, which now succeeds it.

Key differences

Atlanta MSA interaction

• Atlanta MSA hospitals were mandatorily in CJR for hip/knee replacement (MS-DRG 469/470)
• Atlanta MSA hospitals participating in BPCI Advanced could not also include MJRLE under BPCI Advanced (CJR took precedence for those episodes)
• For non-MJRLE bundles (cardiac, sepsis, stroke, etc.), Atlanta MSA hospitals could participate in BPCI Advanced

TEAM: the mandatory successor (January 1, 2026)

The Transforming Episode Accountability Model (TEAM) is the mandatory successor to BPCI Advanced (and to CJR), finalized in the FY 2025 IPPS Final Rule (CMS-1808-F, 89 FR 68986) with refinements in the FY 2026 IPPS Final Rule (CMS-1833-F). CMS selected 188 Core-Based Statistical Areas (about 741 hospitals) for mandatory participation.

TEAM key features

• Mandatory for acute care hospitals in selected MSAs
• Performance Period: January 1, 2026 – December 31, 2030 (5 years)
• 5 clinical episode categories:
  1. Lower Extremity Joint Replacement (LEJR)
  2. Surgical Hip/Femur Fracture Treatment (SHFFT)
  3. Spinal Fusion
  4. Coronary Artery Bypass Graft (CABG)
  5. Major Bowel Procedure
• 30-day episode duration (shorter than BPCI Advanced's 90 days)
• Three tracks (similar to ACO REACH structure) with different risk levels
• Advanced APM status for selected tracks

Georgia hospitals in selected MSAs will be subject to TEAM regardless of their prior BPCI Advanced participation. The TEAM final rule lists the selected MSAs.

Georgia BPCI Advanced participation

Selected Georgia health systems and PGPs participated in BPCI Advanced across various clinical episode categories over its run:

Integrated health systems

• Wellstar Health System: selected bundle participation
• Emory Healthcare: selected bundle participation
• Piedmont Healthcare: selected bundle participation
• Northside Hospital System: selected bundle participation
• Grady Health System: selected participation
• Augusta University Health: selected participation

Physician group practices

• Selected Georgia orthopedic groups (often in MJRLE under Convener)
• Selected Georgia cardiology groups (CABG, AMI, PCI bundles)
• Selected surgical specialty groups

Conveners operating in Georgia

• Signify Health (formerly Remedy Partners): major Convener
• Premier, Cardinal Health, and other specialty Conveners

Participation varied year to year as bundles were added or dropped. Specific participant lists are CMS-maintained; the model concluded December 31, 2025 regardless.

14 best practices BPCI Advanced participants used

These were the operational levers that drove BPCI Advanced performance; they carry directly into TEAM-era episode management:

1. Post-acute care optimization: most savings come from reducing post-acute spending (SNF days, IRF use, home health intensity)
2. Risk stratification at admission: identify high-cost-risk episodes early and route to intensive case management
3. Readmission prevention: strong transitions, follow-up appointments within 7 days, medication reconciliation
4. SNF network curation: partner with preferred SNFs that align with bundle goals
5. Home health integration: strong home health partners with bundle-aligned protocols
6. Episode-specific clinical pathways: standardize care for each clinical episode category
7. Care navigators / care managers: staff invested in 90-day episode follow-through
8. Internal cost benchmarking: know your own baseline cost and where opportunities lie
9. Convener analytics use: leverage Convener's data and benchmarking
10. MJRLE protocols: reduce ALOS, shift to home discharge, reduce SNF days, optimize physical therapy
11. CHF/COPD management: focus on medication adherence, transitions, and home health for these high-readmission bundles
12. Cardiac bundle optimization: CABG and AMI bundles benefit from cardiac rehab and tight cardiology follow-up
13. Sepsis bundle optimization: early identification, antibiotic stewardship, post-discharge surveillance
14. Quality measure tracking: readmission rates, advance care planning, and complication rates all affect NPRA quality adjustment

14 common BPCI Advanced issues participants faced

1. Post-acute spending overruns: the largest source of NPRA losses
2. Readmission spikes: 90-day all-cause readmission directly drives episode spending and quality adjustment
3. SNF length-of-stay drift: without active management, SNF days exceed bundle targets
4. Patient acuity mix shifts: outlier episodes can drive bundle losses despite good population management
5. Bundle selection misalignment: selecting bundles where the participant lacks improvement opportunity
6. Convener fee structures: net NPRA after Convener fees may be lower than expected
7. Target Price methodology updates: annual recalculation can shift targets unfavorably
8. CJR overlap: Atlanta MSA hospitals cannot double-count MJRLE under BPCI Advanced
9. PGP attribution complexity: physician attribution rules for QP determination can be confusing
10. Data lag: episode reconciliation occurs months after episodes complete
11. Patient transfer complications: patient transfers between hospitals can create attribution disputes
12. Quality measure submission gaps: incomplete quality data hurts NPRA quality adjustment
13. TEAM transition planning: hospitals had to plan for TEAM mandatory participation, which began January 1, 2026
14. APP reporting (for non-QP physicians): non-QP MIPS-eligible BPCI Advanced clinicians must submit APP at APM Entity level

Six worked examples: how BPCI Advanced episodes worked for Georgia Medicare beneficiaries

These illustrative examples show how a 90-day BPCI Advanced episode played out during the model's run (October 1, 2018 – December 31, 2025).

1. Fulton 70: Atlanta hospital MJRLE bundle

A 70-year-old Atlanta beneficiary undergoes elective total hip replacement at an Atlanta hospital. Because the Atlanta MSA was in CJR (mandatory), her hip replacement fell under CJR, not BPCI Advanced. However, the hospital could simultaneously participate in BPCI Advanced for other episodes (cardiac, sepsis, etc.).

2. DeKalb 75: DeKalb cardiac valve bundle

A 75-year-old DeKalb beneficiary undergoes surgical aortic valve replacement at a DeKalb hospital participating in BPCI Advanced for Cardiac Valve Procedures. The 90-day episode began with admission and included the anchor stay, cardiac surgery physician fees, ICU recovery, SNF or IRF if needed, cardiac rehabilitation, and any readmissions through day 90. The hospital's bundle performance against Target Price determined NPRA.

3. Cobb 68: Cobb COPD bundle

A 68-year-old Cobb beneficiary is admitted with COPD exacerbation at a Cobb hospital participating in BPCI Advanced for the COPD bundle. The 90-day episode included anchor hospitalization, post-discharge pulmonary rehabilitation, home health, follow-up pulmonary visits, and any readmissions. The hospital invested in COPD discharge protocols, pulmonary rehab referrals, and tight follow-up to keep this episode under Target Price.

4. Worth County 72: Albany sepsis bundle

A 72-year-old Worth County beneficiary is hospitalized for severe sepsis at an Albany-area hospital participating in BPCI Advanced for Sepsis. The 90-day episode included anchor hospitalization, a post-acute SNF stay, home health, follow-up infectious disease and primary care visits, and any readmissions. Post-acute care optimization and readmission prevention were the levers for bundle success.

5. Bibb 80: Macon CHF bundle

An 80-year-old Bibb beneficiary is admitted with acute decompensated CHF at a Macon hospital participating in BPCI Advanced for CHF. The 90-day episode was dominated by post-discharge medication management, cardiac follow-up, home health, and readmission prevention. CHF was one of the highest-readmission bundles; strong post-discharge management was critical.

6. Hall 67: Gainesville stroke bundle

A 67-year-old Hall County beneficiary is hospitalized for ischemic stroke at a Gainesville hospital participating in BPCI Advanced for Stroke. The 90-day episode included anchor hospitalization (potentially including thrombolytic or thrombectomy treatment), inpatient rehabilitation or SNF, outpatient stroke rehab, primary care and neurology follow-up, and readmissions. Stroke rehabilitation intensity and quality determined both clinical outcomes and bundle performance.

Frequently asked questions

General BPCI Advanced questions

1. What was BPCI Advanced? BPCI Advanced was the CMS Innovation Center's voluntary 90-day episode-based bundled payment model that operated across dozens of inpatient and outpatient clinical episode categories. Participants were accountable for total Medicare Part A and Part B spending during each episode against a risk-adjusted Target Price. The model concluded December 31, 2025.

2. Who ran BPCI Advanced? The CMS Innovation Center (CMMI) operated BPCI Advanced under Section 1115A SSA authority.

3. When did BPCI Advanced operate? October 1, 2018 through December 31, 2025, across seven Model Years. It was extended twice (originally set to end in 2023), with a third cohort beginning January 1, 2024.

4. What replaces BPCI Advanced after December 2025? The Transforming Episode Accountability Model (TEAM), a mandatory bundled payment model in selected MSAs covering 5 clinical episode categories, which launched January 1, 2026.

5. Does Georgia have BPCI Advanced participants? Yes. Selected Georgia hospitals (Wellstar, Emory, Piedmont, Northside, and others), PGPs, and Conveners participated.

Episode and payment questions

6. How long was a BPCI Advanced episode? 90 days. The episode started on the date of the anchor inpatient admission or anchor outpatient procedure and ended 90 days post-discharge or post-procedure.

7. What did an episode include? All Medicare Part A and Part B spending during the 90-day window: anchor hospitalization, physician services, post-acute care (SNF, IRF, LTCH, home health), readmissions, outpatient services, and Part B drugs.

8. What was the Target Price? A risk-adjusted bundle-specific price calculated from the participant's historical baseline spending, trended forward and discounted by 2-3% to represent CMS's share of expected savings.

9. What was NPRA (Net Payment Reconciliation Amount)? The annual reconciliation amount comparing actual episode spending against Target Price. Positive NPRA = participant earned savings; negative NPRA = participant owed losses. NPRA was capped at ±20%.

10. Was the NPRA risk one-sided or two-sided? Two-sided: both upside (earned savings) and downside (owed losses) exposure. Two-sided risk is what qualified BPCI Advanced as an Advanced APM.

Participant questions

11. Who could participate in BPCI Advanced? Acute care hospitals, physician group practices (PGPs), and convener participants that aggregated multiple episode initiators.

12. Was participation voluntary? Yes. BPCI Advanced was entirely voluntary. (TEAM, the successor, is mandatory in selected MSAs and began January 1, 2026.)

13. Could participants select which bundles to include? Yes. Participants elected specific clinical episode categories and could add or drop categories between Model Years.

14. What was a Convener? A Convener Participant aggregated multiple Episode Initiators (hospitals or PGPs) under a single BPCI Advanced participation arrangement. Conveners often provided analytics, infrastructure, and shared risk. Examples included Signify Health (Remedy Partners) and Premier.

Beneficiary questions

15. Do Medicare beneficiaries enroll in BPCI Advanced? No. Beneficiaries did not enroll. They were claims-based attributed when their anchor stay or procedure occurred at a participating hospital or PGP.

16. Can beneficiaries opt out of BPCI Advanced? No, but BPCI Advanced was operationally invisible to beneficiaries. They retained full Medicare FFS benefits and rights.

17. Does BPCI Advanced affect beneficiary cost-sharing? No. Standard Medicare Part A and Part B cost-sharing applies; BPCI Advanced did not change beneficiary cost-sharing.

18. Can beneficiaries see any provider during the 90-day episode? Yes. Beneficiaries retained full Medicare FFS freedom of choice. The participant could not restrict beneficiary choice of post-acute provider.

Advanced APM / QP questions

19. Was BPCI Advanced an Advanced APM? Yes. BPCI Advanced satisfied the three Advanced APM criteria (CEHRT, quality measurement, and meaningful two-sided risk) and qualified as an Advanced APM under Section 1833(z) SSA.

20. Could BPCI Advanced participants achieve QP status? Physician participants in PGPs or Conveners could achieve QP/Partial QP status if attribution thresholds were met. Hospital-only participation did not directly produce QP status for hospital-employed physicians.

21. What did QP status provide? MIPS exemption and APM Incentive Payment (5% PY 2018-2022, 3.5% PY 2023) or the Qualifying APM Conversion Factor differential (PY 2024+).

Relationship questions

22. How did BPCI Advanced relate to CJR? CJR was mandatory for hip/knee replacement in selected MSAs (including Atlanta MSA). BPCI Advanced was voluntary. Atlanta MSA hospitals could not include MJRLE under BPCI Advanced (CJR took precedence) but could include non-MJRLE bundles. Both models were precursors to the mandatory TEAM model.

23. How did BPCI Advanced relate to MSSP / ACO REACH? A beneficiary could simultaneously be in an MSSP or ACO REACH attribution and a BPCI Advanced episode. Attribution overlap rules determined how spending was counted; generally BPCI Advanced episode spending continued to be ACO-attributable for the ACO's total cost of care.

24. What is TEAM? The Transforming Episode Accountability Model, BPCI Advanced's mandatory successor, which began January 1, 2026 in selected MSAs (188 CBSAs, about 741 hospitals), covering 5 clinical episode categories with a 30-day episode duration.

25. Where can Georgia stakeholders learn more? innovation.cms.gov for BPCI Advanced and TEAM model details. QPP Service Center (1-866-288-8292) for QP/APP questions. Palmetto GBA (1-866-238-9650) for claims processing.

Contact resources

Federal Medicare resources

• Medicare (general): 1-800-MEDICARE (1-800-633-4227)
• CMS Innovation Center: innovation.cms.gov
• QPP Service Center: 1-866-288-8292
• Palmetto GBA (Part A/B MAC Jurisdiction J): 1-866-238-9650

Georgia state resources

• GeorgiaCares SHIP: 1-866-552-4464 (free Medicare counseling)
• 211 Georgia: 2-1-1
• Georgia Department of Community Health: dch.georgia.gov
• Georgia Aging and Disability Resource Connection: 1-866-552-4464

Beneficiary advocacy

• Medicare Rights Center: 1-800-333-4114
• Eldercare Locator: 1-800-677-1116
• Atlanta Legal Aid: 404-377-0701
• Georgia Legal Services: 1-800-498-9469
• Acentra Health QIO: 1-844-455-8708

Federal benefit administration

• Social Security Administration: 1-800-772-1213
• Benefits Coordination & Recovery Center (BCRC): 1-855-798-2627

Provider/practice resources

• NAACOS: naacos.com
• AMA QPP resources: ama-assn.org
• Medical Association of Georgia (MAG): mag.org
• Georgia Hospital Association: gha.org

Why BPCI Advanced matters

BPCI Advanced was Medicare's proving ground for episode-based bundled payment accountability for seven years. By holding hospitals, PGPs, and conveners accountable for 90 days of Medicare spending across dozens of clinical episode categories, and by structuring the model as an Advanced APM with two-sided risk, BPCI Advanced demonstrated what voluntary episode-based payment can achieve. For Georgia hospitals and specialty practices that participated, it was a vehicle for reducing post-acute care overuse, improving care coordination, and earning shared savings on well-managed episodes. Now that BPCI Advanced has concluded as of December 31, 2025 and the mandatory TEAM model has taken effect January 1, 2026, the lessons learned in BPCI Advanced directly inform how Georgia hospitals navigate the next phase of bundled payment, a phase where mandatory participation, shorter episode durations, and an evolving set of clinical episode categories are the new operating frame.

Learn More

• Georgia Medicare CMS Innovation Center
• Georgia Medicare Shared Savings Program (MSSP)
• Georgia Medicare ACO REACH
• Georgia Medicare Quality Payment Program (QPP)
• Georgia Medicare Qualifying APM Participant (QP)
• Georgia Medicaid Overview

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