Expert Insight into Bundled Payments

Actionable Insights at Your Fingertips

hands on keyboardWhile the transition from fee-for-service to value-based payments continues in a slow-but-steady manner, MedBen Analytics has been evolving with it. We make changes to our software platform based on client feedback and CMS activity… and we’d welcome the opportunity to show you how we turn Medicare claims data into actionable insights.

Scheduling an online MedBen Analytics demonstration gives you a first-hand look at our bundled payment reporting portal without leaving your desk… and takes just 45-60 minutes of your time. During the demo, a team member will show you the following features of MedBen Analytics up close:

Drill-down capability. Look at summary reports that give you the big picture, or click on graphs and tables to get more detailed information – right down to specific claims data.

Benchmarking. See how you compare to local and regional competition as well as measuring your own past and present results, to help you strategize for the future.

Portability. All reports are easily exportable into a PowerPoint deck, Word or PDF document, or Excel spreadsheet with one click.

Customization. We can create specialized reports based on your organization’s specific needs.

The demo is free and requires no further obligation on your part. It’s our expectation that once you’ve seen MedBen Analytics in action, the advantages will speak for themselves. To schedule a demo, simply contact MedBen Manager of Operations Cari Coventry at 800-423-3151, Ext. 405 or email

Radiation Oncology Bundled Payment Model Delayed Until 2022?

radiation therapyMedTech Dive reports that the Centers for Medicare & Medicaid Services (CMS) has placed the proposed regulation for a mandatory radiation oncology alternative payment model (RO-APM) on its long-term agenda. Originally scheduled for an implementation date as early as January 1, 2020, the new regulatory agenda now lists July 2022 as a target… though CMS doesn’t rule out an earlier implementation date if possible.

Proposed by the CMS in July, the radiation oncology model has received push back on multiple fronts. Electronic health record companies have requested an implementation date later than January 2020, while the American Medical Association has lobbied for a more limited, voluntary model.

As written, the RO-APM proposed rule will establish a bundled payment system for 40% of Medicare radiation oncology episodes, with the goal of saving up to $260 million over a five-year period. However, a CMS spokesperson told MedTech Dive that RO-APM is still “in the rulemaking process and has not yet been finalized.”

MedBen Analytics will continue to monitor the progress of the radiation oncology model and will update you when we have additional information. In the meantime, if you have any questions about RO-APM or are interested in viewing a demo of our current reporting platform, please contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or

Helping Providers Uncover Wasteful Spending

stethoscope and dollarA recent study found that waste accounts for about 25% of U.S. health care spending, with wasteful spending costing Americans between $760 billion to $935 billion annually. Researchers determined that the highest amount of wasteful spending was linked to administrative complexity, and cited value-based payment models as a possible remedy.

“In value-based models, in particular those in which clinicians take on financial risk for the total cost of care of the populations they serve, many of the administrative tools used by payers to reduce waste (such as prior authorization) can be discontinued or delegated to the clinicians, reducing complexity for clinicians and aligning incentives for them to reduce waste and improve value in their clinical decision-making,” the study authors wrote.

MedBen agrees that bundled payment models and other value-based initiatives have the potential to find and eliminate health care spending waste. Toward that goal, we developed MedBen Analytics to give hospitals, health systems and other providers the actionable insights needed to uncover inefficiencies and maximize quality care delivery.

Using the MedBen Analytics software platform, the user can access straightforward, interactive reports that give them a clear picture of what works and where opportunities for improvement exist. We organize and interpret the data so our clients can focus on making informed decisions.

Learn more about how MedBen Analytics can help your organization reduce wasteful spending by visiting our website or contacting Manager of Operations Cari L. Coventry at 800-423-3151, ext. 405 or

MedBen Analytics Advances with APM Transition

A recent report indicates that the health care industry is making a slow but steady transition from fee-for-service to bundled payments and other alternative payment models (APMs) where reimbursement is based on quality rather than quantity.

According to the Health Care Payment Learning & Action Network (HCP-LAN), in 2018 approximately 35.8 percent of health care payments were tied to an APM and 25.1 percent were fee-for-service tied to value and quality. Only 39.1 percent of payments were fee-for-service with no value or quality link.

While falling short of Health and Human Services’ previous goals, these numbers do suggest that APMs will soon become the norm for provider payments. And since 2015, MedBen Analytics has been helping health systems make a smooth changeover to value-based care.

As bundled payment models are introduced and fine-tuned, so too does MedBen modify its software platform to ensure that providers have the most accurate analysis available. We provide a variety of actionable reports with the ability to drill down and find opportunities that impact care delivery.

Moreover, the lessons we’ve learned have crossed over to other businesses. Our all-inclusive commercial bundled payment services bring together self-funded employers with health care facilities to provide joint replacement services. Employers know exactly what they must pay, while providers benefit from agreed-upon payments and increased steerage.

If you’re interested in seeing how MedBen Analytics reporting works up close, we’d be happy to give you a demonstration. Just contact our Manager of Operations Cari L. Coventry at 800-423-3151, ext. 405 or

CJR Participants Preparing for Bundled Payment Future

doctor and patientIn a recent evaluation of Performance Years 1 and 2 for the Comprehensive Care for Joint Replacement (CJR) model, the Center for Medicare & Medicaid Innovation (CMMI) surveyed participant hospitals on the strategies they employed to improve care coordination toward the goal of reducing costs while maintaining quality.

Of the 196 hospital survey respondents:

  • 89% reported implementing same-day post-surgery ambulation and physical therapy
  • 81% reported scheduling follow-up appointments for all lower extremity joint replacement (LEJR) patients prior to discharge
  • 65% reported implementing repeated telephonic follow-up during the entire 90-day episode
  • 61% felt that physician engagement in care redesign activities had improved since the CJR model

According to the CMMI evaluation, “Many hospitals interviewees indicated the opportunity to prepare for future bundled payment models was a strong motivating factor in responding to the CJR model.” But achieving real success in bundled payments requires accurate and actionable data analysis – and MedBen Analytics offers the necessary reporting tools to help hospitals, health systems and other providers make a smart transition from fee-for-service to value-based care.

Additionally, as hospitals learn from the lessons of CJR and other models, so too does MedBen Analytics. Regular client feedback and internal observations based on our claims management experience enable us to make regular enhancing our software platform. Plus, we extend these lessons to improving our commercial bundled services as well.

For further information about how MedBen can help you develop bundled payment strategies, please contact Manager of Operations Cari L. Coventry at 800-423-3151, ext. 405 or

Value-Based Care Transition Calls for Sound Data Analysis

Inside Health Policy recently reported that Sanjay Doddamani, a senior adviser at the Center for Medicare and Medicaid Innovation, stated that the center aims to move all beneficiaries in fee-for-service Medicare into alternative payment models by 2025. And while the growth of value-based care has slowed from earlier timelines, such comments do indicate that the federal government appears “all in” on an eventual transition to Medicare payments tied to quality treatment.

With the likelihood that more bundled payment models will be announced in the coming months and years, it becomes more essential that participants have access to sound Medicare data analysis. The goal of MedBen Analytics is to make sure that all providers can benefit from value-based care.

As bundled payment models evolve, MedBen Analytics builds on positive results with targeted enhancements to our software platform using a combination of client feedback, internal studies and external information. In this way, we ensure that providers will have actionable reports to help improve quality of care, reduce length of stays and readmissions, and lower treatment costs, while not significantly affecting administrative workload.

We developed MedBen Analytics to give health systems the insights they need to improve performance – and we earn and keep clients by proving that bundled payment data allows health systems to create standardized care paths for pre-hab, the anchor procedure, and post-acute care. This allows vested physicians to goal set and measure a product line’s overall performance. In the long term, product lines participating in quality-driven bundled payments will realize savings in time and money while increasing patient outcomes over traditional fee-for-service.

If you ever have questions about how MedBen Analytics can benefit your business, please call Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or

MedBen Launches Revamped Website

hands on keyboardIn addition to providing bundled payment insights to health care systems, MedBen offers a wide variety of benefit solutions… and on the newly revamped website, you can see for yourself why we’re “the benefits partner that employers prefer.”

For over 80 years, MedBen has served the health benefit needs of employers – and that includes third party administration for hospitals and health systems, which constitute one of our largest blocks of self-funded business. Our new site highlights our TPA services, as well as our pharmacy solutions, ancillary products and worksite wellness programs that subscribe to a “physician first” philosophy.

Our TPA page also highlights alternative coverage strategies, such as all-inclusive commercial bundled payment services for self-funded employers. We bring together employers with health care facilities to provide joint replacement services under bundled case agreements. Through these arrangements, employers know exactly what they must pay for a joint replacement procedure, while providers benefit from agreed-upon payments up front and increased steerage to their facilities.

And just a reminder… if you are looking for more information about how you can unlock more value from bundled payments, please visit to learn now we convert your Medicare data into actionable insights. Or, schedule a demonstration of our software platform by contacting Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or

Insightful Data Analysis Helps Reduce Post-Hospital Care Costs

medical assessment at homeA new University of Michigan study reveals that Medicare spends about $60 billion more per year on post-hospital care than private insurance. It’s a disparity that demonstrates the urgent need to find sensible alternatives to the standard fee-for-service arrangement.

As an article about the study notes, the Centers for Medicare and Medicaid Services (CMS) is working to “incentivize more judicious use of post-acute care in Medicare through the introduction of alternative payment models,” including bundled payments.

Recent research of the Comprehensive Care for Joint Replacement (CJR) model shows that slow but significant progress is being made in reducing care costs without sacrificing quality, with much of the savings tied to post-hospital treatment. As more bundled payment models are introduced, the hope is that Medicare spending will better reflect the true cost of quality care while still properly compensating providers at all points of the patient journey.

To accomplish this goal requires strong data analysis to uncover inefficiencies and make improvements. The MedBen Analytics reporting platform is designed to help your business evolve with the changes in health care payments by feeding relevant payment information to your decision makers.

We designed MedBen Analytics with the express purpose of maximizing the value of care provided to patients. Our insights decrease ineffective costly treatment while helping providers to ensure the best patient care.

We’d be happy to show you how our reporting platform can work to your best advantage. To set up a demonstration, please contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or

MedBen Analytics Helps Health Systems Navigate Bundled Payments

As health care economics evolve, bundled payments will be the standard for how reimbursements work – and providers not knowledgeable about how they work risk falling behind. The MedBen Analytics software platform gathers, organizes and helps interpret the data that health systems need to navigate bundled payments and unlock more value.

Are you examining the data-driven relationship between quality scores and readmissions? Are you providing too many post-acute care services? Whatever questions matter to you, we present data according to the unique characteristics of your system.

MedBen Analytics reports go from the Treetops to the Trenches. If you’re looking for a summary report with high-level information, we’ve got you covered. If you want specific information about a claim, we can go all the way down to the claim line level with just a few clicks.

Additionally, all MedBen Analytics reports are easily exportable into a PowerPoint deck, Word or PDF document, or Excel spreadsheet with one click. This allows you to get the key information you need to communicate to decision makers quickly and easily.

MedBen Analytics is designed with the express purpose of maximizing the value of care provided to patients by decreasing ineffective and costly treatment while helping health systems to ensure the best patient care. We’d be happy to show you how our reporting platform can work to your best advantage. To set up a demonstration, please contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or

Radiation Oncology Proposal Diverges from Prior Bundled Payment Models

radiation therapyLast month, the Centers for Medicare & Medicaid Services (CMS) announced a proposal for a new mandatory radiation oncology (RO) bundled payment model to begin in early 2020. As MedBen Analytics reported after the announcement, the 5-year model would use Medicare data to assess patient outcomes for 17 types of cancer.

Like the current Comprehensive Care for Joint Replacement (CJR) Model, radiation oncology providers would be randomly selected to participate in the RO Model, and payments would be linked to quality metrics rather than fee-for-service. But Health Affairs notes that the RO Model does depart from earlier mandatory bundled payment programs in three distinct ways:

  1. CMS intends to pay RO Model participants on a prospective basis using separate payments for professional and technical components of care.
  2. CMS proposes site neutral payments, using an episode-pricing model that reimburses participants based on hospital-outpatient department rates, irrespective of site of care.
  3. Randomized participation in the CJR Model was limited to selected metropolitan statistical areas, while the proposed RO Model would also select providers from non-rural “micropolitan” areas.

Despite these differences, the CJR and RO Models will share an important attribute: Provider payments will be directly impacted by quality and reporting.

CMS has posted the proposed RO Model rule on the Federal Register. Those who wish to submit a formal comment on the rule may do so until September 16, 2019, at 5 p.m. ET.

As additional information becomes available about the RO Model, we’ll report it in future editions of MedBen Analytics insight. In the meantime, providers with questions about any aspect of bundled payment programs are welcome to contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or