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Bundled Payments for Care Improvement Evaluation (BPCI)


  • There is concern that providers’ efforts to reduce costs may jeopardize quality.
  • Abt evaluated whether measures of patient functional status and care experience changed under BPCI.
  • Patients are receiving sufficient care, but there may be room for improvement in customer experience.
The Challenge

Under traditional Medicare, the Centers for Medicare and Medicaid Services (CMS) pays providers separately for each service delivered, which may incentivize medically unnecessary care.  Providers who participate in CMS’s Bundled Payment for Care Improvement (BPCI) are given a target price for all care within a given time period.  If providers deliver care under the target price, they will receive payments equal to the difference.  While the goal is to deliver higher quality care more efficiently by eliminating unnecessary services and improving care coordination, there is concern that providers may be incentivized to deliver less-than-optimal care.

The Approach

Abt partnered with The Lewin Group to perform a mixed methods evaluation of the BPCI initiative. Abt surveyed nearly 200,000 Medicare beneficiaries to determine whether self-reported physical function or patient care experiences varied between patients treated by BPCI participants and those treated by non-BPCI providers.  We also estimated changes in clinician assessments of patient’s physical functional status at post-acute care facilities attributed to BPCI.  Finally, Abt staff visited post-acute care providers participating in BPCI to interview key staff about their experience with BPCI.

The Results

We found that survey respondents treated by BPCI participants were slightly less likely than control respondents to report the highest levels of satisfaction with recovery or care experience.  However, we did not find any evidence of differences in self-reported physical functionality between the two groups. These findings reduce concerns that BPCI may have unintentionally harmed patients’ health but suggest there’s room for improvement in patients’ care experience.