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Expert Insight into Bundled Payments

Voluntary, Mandatory Models Go Head-to-Head in New Report

A new report by the Government Accountability Office (GAO) compares voluntary and mandatory bundled payment models, and may offer a hint as to which one comes out ahead.

The GAO examined six Medicare episode-based payment models that were in place in early 2018, the lone mandatory model of which was Comprehensive Care for Joint Replacement (CJR). Participants in these models tended to be located in urban areas and had higher episode volume than non-participating Medicare providers.

Providers in the voluntary models were attracted by the greater participant incentives compared to mandatory models, including the ability to choose episodes that offered opportunities to implement care redesign and earn performance bonuses. Conversely, the report found that, because the mandatory models require participation, they offer a more representative sample of providers. This allows for more generalizable results, greater financial risk notwithstanding.

Since models like CJR encourage a quicker transition from traditional Medicare to value-based care, Health and Human Services Alex Azar has made known his preference for the mandatory approach… and taken in turn with the GAO findings, would indicate that we’ll be seeing more mandatory models going forward, says MedBen President & CEO Kurt Harden.

“The GAO report makes the case that while voluntary models have their place for testing feasibility and novel concepts, mandatory models offer more useful information for improving quality and savings,” Harden said. “It may not make participants happy, but if you want to control costs, mandatory is the way to go.”

Regardless of the direction bundled payment models do ultimately take, MedBen Analytics is ready to help hospitals, health systems and other providers achieve positive results from their participation. We work with both voluntary and mandatory models, and the insights offered through our innovative reporting software platform will enable your organization to ensure the highest level of care while unlocking profit potential.

If you’d like to see a demonstration of our system or want additional information about MedBen Analytics, please call Harden at 888-633-2364 or email kharden@medben.com.

CJR Study Results: Modest Savings, But Promising Future

New Harvard University research shows promising results for the Comprehensive Care for Joint Replacement (CJR) model. As published in the New England Journal of Medicine, a two-year study of bundled payments for hip and knee replacement surgeries found an average savings of $812 per event – a 3.1% cost reduction when compared to fee-for-service payments.

Most of the cost savings resulted from the increased use of post-procedural home health care in lieu of skilled nursing facilities. However, the researchers predicted further savings as the bundled payment model moves forward, noting that interest has “exploded” in recent years.

The researchers also found that, despite earlier concerns that bundled payments would incentivize providers to favor healthier, less costly patients, there was little impact on the number of higher-risk patients who received lower extremity joint replacements under the CJR model. Additionally, the use of bundled payments did not affect patient complication rates.

So while it’s still too early to draw definitive conclusions, these findings bode well for the future of CJR and value-based care in general. And as providers become more acclimated to bundled payment models, MedBen also takes the lessons learned from these models and applies them to our data reporting platform.

From the outset, the goal of MedBen Analytics was to help hospitals, health systems and physician groups use bundled payments to the best advantage of patient and provider alike. We designed our software to provide the information necessary to make informed care decisions, and offer that information in a practical, intuitive format. And we continually make modifications that reflect our collective knowledge so as to provide even greater insights.

We invite you to see for yourself how MedBen Analytics bundled payment solutions can benefit your organization. To set up a demonstration of our reporting platform, please contact MedBen President & COO Kurt Harden at 888-633-2364 or email kharden@medben.com.

A Note from our President: In 2019, Expect Change and Continued Growth

Kurt Harden, MedBen President & CEOHappy New Year from the MedBen Analytics team, as well as everyone else at MedBen! I hope that 2019 brings you good health and prosperity.

As the old song (sort of) goes, what a difference a year makes! In January 2018, I wrote about how the cancellation of several mandatory bundled payment initiatives by the Department of Health and Human Services would indicate that the future growth of value-based care hinges on voluntary participation. Positive response to the voluntary Bundled Payments for Care Improvement Advanced (BPCI Advanced) model introduced last March only served to further drive home the point.

But a change of leadership at HHS brought with it a change in perspective. Rather than echo his predecessor’s preference for voluntary participation, current Director Alex Azar revealed in November that he may revisit the possibility of mandatory models. No decision has been formally announced, but the initial indication is that in 2019, we will see the eventual rollout of a new mandatory initiative, most likely related to cardiac care.

We enter 2019 with many “ifs” flying around. Regardless, MedBen Analytics continues to be bullish about the long-term success of value-based care in general and bundled payments specifically. We remain committed to helping participating hospitals, health systems and physician groups achieve that success.

MedBen believes that the true buy-in from providers will only happen when a majority see first-hand how value-based care benefits them across the board — improving quality of care, reducing length of stays and readmissions, and reducing treatment costs, while at the same time not significantly affecting administrative workload. And while that’s a pretty tall order, we’re confident that our data analytics and reporting platform will continue to meet that criteria and provide the insights necessary to unlock value and efficiency

As always, we value your input. If you ever have a comment, question, or suggestion, do not hesitate to call me at 888-633-2364. I wish you all the best in 2019 and look forward to working with you.

Respectfully,

Kurt Harden
President & CEO, MedBen

Services That Make Bundled Payments Work For You

One goal of the insight newsletter is to place MedBen Analytics in a broader real-world context. But that’s not to say that the benefits of our bundled payment reporting platform don’t stand on their own!

If you haven’t checked out the MedBen Analytics website yet, we encourage you to stop by for a visit. There, we break down our services and how they can make bundled payments work for you.

  • Data Presentation. Our audience-specific reports and dashboards hold various stakeholders make better decisions.
  • Data Insights. We break down insights from surgeon performance to post-acute care, performance and readmission rates, and other categories.
  • Action Plan. What’s your next step once you understand what the data means? We’ll help you weigh the options and create a plan.
  • Measurement. How well is your plan working? We can help you compare your past and present results – from efficiencies to profits – and strategize for the future.

Of course, even a detailed description of our services can’t give you the total picture. For that, we invite you to schedule an online MedBen Analytics demonstration, and see for yourself how our advanced software turns Medicare claims data into actionable insights. We’ll highlight our reporting portal’s drill-down capability, customization, and other useful features.

The demo is free, takes just 30-45 minutes, 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 call MedBen President & COO Kurt Harden at 888-633-2364 or email kharden@medben.com.

Successful Value-Based Care Begins with Smart Data Usage

A recent CIOReview article examined the key insights to provide value-based care… and not surprisingly, it notes that intelligent use of data and analytics is the foundation that health systems should build upon to succeed with bundled payments and other alternative payment models:

“Data and analytics have high potentials to help in improving the healthcare system and clinician performance… by leveraging modern analytics, [human resources] can be focused on areas that produce the greatest ROI.”

MedBen Analytics understands the critical role data plays in value-based care. Working with disparate data increases the risk of poor choices and internal miscommunication, so our bundled payment platform helps you gather, organize, and better interpret the data.

Once MedBen Analytics has converted the raw data into relevant and timely reporting, your decision-makers are better positioned to make the smart conclusions that can translate into more efficient care. Our insights lead to more focused intra-clinical communication, as well as more effective patient hand-offs, helping to reduce readmissions.

MedBen has over eight decades of benefits management experience… a unique perspective that we brought to the creation of bundled payment solutions. See for yourself how MedBen Analytics delivers actionable insights that turn your data into decisions (and dollars) by scheduling a demo today. Simply call MedBen President & CEO Kurt Harden at 888-633-2364 or email kharden@medben.com.

HHS May Revisit Mandatory Bundled Models

In a surprising move, the Department of Health and Human Services (HHS) recently announced that it may still implement mandatory bundled payment models… including several initiatives that were cancelled last year.

Speaking at the Patient-Centered Primary Care Collaborative Conference on November 8, HHS Secretary Alex Azar said the agency has reexamined its approach to value-based care. “Real experimentation with episodic bundles requires a willingness to try mandatory models. We know they are the most effective way to know whether these bundles can successfully save money and improve quality,” he said.

Azar’s comments stand in sharp contrast to previous HHS head Tom Price, who cited a preference for voluntary programs as the reason for abandoning mandatory hip fracture and cardiac bundled payment models in November 2017. In addition to revisiting some of the mandatory cardiac models, Azar said the HHS is “actively exploring new and improved episode-based models in other areas, including radiation oncology.” He noted the agency will consider more voluntary models as well.

Prior to last year’s cancellation, MedBen Analytics had already taken the necessary steps to expand our reporting portal, in order to ensure that health systems affected by the initiatives would have access to the same useful insights our current clients receive. And while those models didn’t come to pass them, our portal is designed to seamlessly accommodate future models, regardless of whether they’re mandatory or voluntary.

From the beginning, the mission of MedBen Analytics has been to provide relevant and timely bundled payment data to all providers. And as value-based care progresses, we will continue to give clients the insights they need to improve performance. If you ever have questions about how our services can help your business, please call MedBen President & CEO Kurt Harden at 888-633-2364 or email medbenanalytics@medben.com.

Next BPCI Advanced Application Period Begins Spring 2019

If you didn’t apply to participate in the Bundled Payments for Care Improvement Advanced (BPCI) Advanced model earlier this year but are still interested in doing so, you don’t have too long to wait. The next application period for BPCI Advanced is scheduled to begin in Spring 2019, with the second cohort starting on January 1, 2020.

The first round of BPCI Advanced applications saw nearly 1,300 providers sign on to participate, including 832 acute care hospitals and 715 physician group practices. The new model runs from October 1, 2018 through December 31, 2023.

For those who participated in (or are familiar with) the original BPCI initiative, the new program offers additional features and incentives, such as:

  • BPCI Advanced qualifies as an Advanced Alternative Payment Model (APM) under the Medicare Access and CHIP Reauthorization Act’s (MACRA’s) Quality Payment Program. Because participants take on additional financial risk, they can earn a five percent bonus.
  • The Advanced model offers participants three outpatient care episodes – Percutaneous Coronary Intervention, Cardiac Defibrillator, and Back & Neck except Spinal Fusion. Meanwhile, inpatient episodes have been reduced to 29 (from the original 48), to better focus on those episodes that have demonstrated the greatest provider interest and potential for return.

The Centers for Medicare & Medicaid Services (CMS) will release additional details about the next application period soon. In the meantime, as with all bundled payment models, MedBen Analytics supports BPCI Advanced participants with actionable insights that turns data into decisions and profit potential. If you have any questions or are interested in viewing a demo of our current reporting platform, please contact Harden at 888-633-2364 or email kharden@medben.com.

First CMS Report on CJR Model Finds Reduced Care Costs

The recently-released first annual report from the Centers for Medicare & Medicaid Services (CMS) on the progress of the Comprehensive Care for Joint Replacement (CJR) model suggests that the bundled payment approach is having the desired result of maintaining quality care while lowering costs and improving patient outcomes.

Based on 2016 information from participating hospitals in the 67 metropolitan statistical areas (MSAs) included in the model, average total payments for CJR episodes decreased by 3.3% compared with control group episodes. MSAs with historically high and low episode payments saw CJR payment reductions of $1,127 and $577, respectively.

A portion of the cost decrease derived from a shift in the post-acute care setting. The report cited a decrease in the use of an inpatient rehabilitation facility (IRF) directly following an elective episode, and a corresponding rise in home health agency use.

The report also found a statistically significant relative reduction in the average number of days CJR patients spent in an institutional post-acute care setting. However, the changes to post-acute settings and durations did not affect the quality of care provided.

In working with CJR participants, MedBen Analytics has seen first hand how bundled payment data can help to make improvements in the delivery of care. Timely and relevant information allows administrators, clinicians, and strategists to compare individual hospital performance (or a hospital system’s performance) to the regional performance. From there, a data-driven dialogue can begin.

Communication based on actionable insights enables internal review of procedures and resources. Clinical and financial goals can then be set and measured, while also reporting and monitoring claims-based quality measures.

We invite you to see for yourself how MedBen Analytics can turn data into informed decisions. To set up a demonstration, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email medbenanalytics@medben.com.

CJR Takes Precedence to Original BPCI Participants

Questions have arisen as to how the end of the original Bundled Payments for Care Improvement (BPCI) initiative affects participants that also happen to be located in a mandatory Metropolitan Statistical Area (MSA) for the Comprehensive Care for Joint Replacement model (CJR), as well as precedence regarding CJR and the new BPCI Advanced model. The Centers for Medicare & Medicaid Services (CMS) recently provided guidance for participating hospitals on these matters.

  • According to CMS, clinical episodes in the BPCI initiative continued to have precedence over CJR clinical episodes until September 30, 2018, the final day of the initiative. Hospitals participating in the BPCI initiative that are located in a mandatory MSA became CJR participant hospitals as of October 1, 2018.
  • Hospitals located in a mandatory MSA are not eligible to participate in BPCI Advanced for CJR episodes. However, they may participate in BPCI Advanced for non-CJR episodes.
  • Under BPCI Advanced, the order of precedence will reverse and all CJR episodes (in either mandatory or voluntary MSAs) will have precedence over BPCI Advanced lower extremity joint replacement episodes.

Participating hospitals with questions regarding these changes or other issues can e-mail CJRSupport@cms.hhs.gov.

The MedBen Analytics reporting platform has provided actionable insights to both BPCI and CJR participants since 2015. If your hospital participated in the BPCI initiative and has questions about the transition to the CJR model, or if you are interested in viewing a demo of our current reporting platform, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email medbenanalytics@medben.com.

Voluntary vs. Mandatory: What’s the Future of Bundled Payment Participation?

On October 1, the Centers for Medicare & Medicaid Services (CMS) will roll out its newest bundled payment model, Bundled Payments for Care Improvement Advanced (BPCI Advanced). This voluntary program builds on the foundation of the original BPCI initiative, which began in 2013 and will end on September 30.

The commitment to further testing the potential of BPCI might suggest that CMS believes that the future of value-based payments is in voluntary participation. Factor in the 2017 cancellation of several mandatory bundled payment initiatives, coupled with a reduction in the number of health systems participating in the Comprehensive Care for Joint Replacement (CJR) model, and it’s easy to conclude that moving forward, voluntary programs will become the norm.

However, the confirmation of Alex Azar as Health and Human Services (HHS) Secretary this past January reopened the possibility that, in spite of the earlier actions, mandatory models may still be a viable option… and indeed, recent comments by Azar indicate we’ll see additional mandatory programs down the road.

“We need strategies and models that provide better care at a lower price, not just new models for the sake of new models and not new systems of payment for old systems that aren’t open to real change,” Azar said at a meeting of the Physician-Focused Payment Model Technical Advisory Committee (PTAC) earlier this month. “In some cases that’s going to mean mandatory models from CMMI [Center for Medicare & Medicaid Innovation] and other mandatory reforms.”

As for what models will be subject to mandatory participation, CMS Administrator Seema Verma says the focus will be on high-cost conditions. “We’re looking at end-stage renal disease, cancer care, chronic disease, [and] individuals with serious medical conditions,” she said at the PTAC meeting.

But regardless of whatever future direction bundled payment models take, MedBen Analytics is ready to help hospitals, health systems and other providers achieve positive results from their participation. We work with both voluntary and mandatory models, and the insights offered through our innovative reporting software platform will enable your organization to ensure the highest level of care while unlocking profit potential.

If you’d like to see a demonstration of our system or want additional information about MedBen Analytics, please call MedBen President & CEO Kurt Harden at 888-633-2364 or email medbenanalytics@medben.com.