Expert Insight into Bundled Payments

HHS Making the Move to Mandatory Models

The Department of Health and Human Services (HHS) has indicated that it expects to move away from voluntary value-based payment models. In recent remarks, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said, “Looking forward, you can expect that some of the models we have under development will be mandatory.”

Verma noted that participation in models like BPCI Advanced have been adversely affected by their voluntary nature. “Selection effects happen when only the providers who would benefit financially from a model choose to participate, thereby reducing the amount of savings that the model can generate,” she said.

“Requiring participation also helps us understand the impact of our models on a variety of provider types, so the data resulting from the model will be more broadly representative,” Verma added.

MedBen President & CEO Kurt Harden said that he’s not surprised by Verma’s comments. “CMS had hoped that the transition to value-based care would be further along by now, and shifting the focus to mandatory models will help to speed up the process,” he said. “It will also produce better data and I believe, better procedural and financial outcomes.”

Whether or not we see more mandatory models down the road, MedBen Analytics is ready to help hospitals, health systems and other providers achieve positive results from their participation. 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

Wherever You Work, MedBen Analytics Works for You

Nearly every state currently has or is implementing a value-based model, new research says. MedBen Analytics extends even further than that Рour bundled payment reporting platform provides actionable insights to hospitals and health systems nationwide.

Even though MedBen calls Ohio home, our clients can be found as far west as California and in many places in-between. We designed our software to help providers interpret applicable Medicare data so they can maximize the value of bundled payments regardless of location.

With MedBen Analytics, users can quickly access and explore variations in the cost of care at all points in the episode. Real-time reports take just seconds to run and enable you to drill down and find opportunities to uncover inefficiencies and make improvements throughout the patient journey.

Moreover, our propriety software leverages the client experience by expanding report options for all clients based on the request of any client. This approach allows all clients to gain from the experience of other clients.

Whether you’re based in Portland, Oregon or Portland, Maine (or anywhere else), MedBen Analytics will work for your benefit. Learn more by visiting or schedule a demonstration by contacting MedBen President & CEO Kurt Harden at 888-633-2364 or

Joint Replacement Study Finds Bundled Payment Savings

On the heels of a two-year Comprehensive Care for Joint Replacement (CJR) cost analysis comes another study further supporting the cost-saving potential of bundled payments for joint replacement episodes.

According to the Journal of Arthroplasty, researchers studied 319 total hip arthroplasty and bilateral total knee arthroplasty patients, 239 of whom were in a bundled payment program. They found that the bundled payment group had reduced hospital costs ($21,251 vs. $18,783), post-acute care costs ($13,488 vs. $12,439) and overall 90-day episode of care costs ($39,733 vs. $34,305). In total, the bundled payment model saved, on average, $5,811 per patient.

“Our bundled payment program… was successful with reduction in 90-day episode-of-care costs without placing the patient at higher risk of readmission,” the researchers concluded.

Like these two studies, MedBen Analytics has seen first-hand the potential of bundled payments to reduce episode of care costs, for mandatory models like CJR as well as voluntary programs. Of course, when lowering costs it’s vital that quality of care not be sacrificed. That’s why our reporting platform gives providers the information necessary to uncover inefficiencies throughout the patient journey while maximizing value.

MedBen Analytics was created specifically to give providers the insights they need to improve performance. By organizing and interpreting Medicare data, our goal is to ensure your success with bundled payments… in service as well as in savings. If you ever have questions about how we can benefit your business, please call MedBen President & CEO Kurt Harden at 888-633-2364 or email

CMS Announces Second Application Period for BPCI Advanced

The Centers for Medicare & Medicaid Services (CMS) has announced that the application period for second cohort of participants in the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model will begin in April 2019. MedBen Analytics, which provides insightful reporting services for voluntary and mandatory bundled payment models, can help your organization make a successful transition to value-based care.

The second cohort of participants will start on January 1, 2020, which is Model Year 3. In its announcement, CMS noted that it does not intend to have additional enrollment periods for Model Year 4 (2021) or Model Year 5 (2022).

Currently, BPCI Advanced consists of 32 bundled clinical episodes – 29 inpatient and 3 outpatient. CMS is finalizing the selection of new clinical episodes for Model Year 3, which will include outpatient Total Knee Arthroplasty (TKA).

In a separate update, CMS reported that following the March 1 deadline for first cohort¬† participants to terminate their participation, the number of participants for Model Year 2 “remains robust at 1,086.” The BPCI Advanced model runs from October 1, 2018 through December 31, 2023.

Whether you’re a current BPCI Advanced participant or plan to apply for the second cohort, MedBen Analytics can help your organization realize the most value from the voluntary bundled care model. Our knowledge of Medicare data consolidation and analysis, backed by over 80 years of experience in medical claims management, will provide you with the information necessary to make improvements through the patient journey while unlocking profit potential.

If you have any questions about the BPCI Advanced program or your how your organization can benefit from bundled payment data insights, please contact MedBen President and CEO Kurt Harden at 888-633-2364 or email

See the MedBen Analytics Advantage for Yourself

Just a brief reminder that the best way to see the actionable insights that MedBen Analytics offers to hospitals, health systems and physician groups is to schedule a demonstration of our bundled payment software platform.

During the demo, which typically takes between 45 to 60 minutes, a team member will guide you through the MedBen Analytics reporting portal and highlight some of its features… among them:

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. We expect that once you’ve seen MedBen Analytics in action, the advantages will speak for themselves. To schedule a demo, simply call MedBen President & CEO Kurt Harden at 888-633-2364 or email

Reporting Insights Benefit Provider, Payer and Patient

A recent employer survey summary highlights five actionable strategies that best-performing companies are using to optimize the value of their health care plan – and coming in at number one is “ensure quality of care through value-based designs.”

The summary states: “Best performers are focused on delivering health care to their employees through value-based designs and contracting that tie payments to quality care and health care outcomes – so cost is based on real results. This model aligns the patient’s and provider’s incentives toward efficient and effective care, preventing reoccurrence of illness and reducing complications, or – when treatment is needed – getting the patient the right care and the right site of service, sooner.

“Seventeen percent of best performers are using bundled payment approaches in their medical plans, compared with only 4% of high-cost companies.”

The wisdom MedBen has gained by working with Medicare data analysis has allowed us to also offer commercial bundled payment services to employers. In doing so, self-funded plans can realize lower costs than fee-for-service payments without compromising quality of care.

Furthermore, because MedBen Analytics has accumulated and researched data on value-based care spending and clinical trends nationwide, we know the cost of high-quality, consumer-focused episodic care. We not only can identify facilities and providers who are overcharging for high-volume procedures, but we can have a meaningful discussion with those facilities and providers about contracting a reasonable commercial rate for an episode of care.

MedBen’s ability to negotiate commercial bundled episodes of care with statistics on clinical utilization and cost ensures that clients are effectively spending their health plan dollars.

MedBen Analytics draws on its experience to benefit all participants in the patient journey… see for yourself by scheduling a demo today. Simply call MedBen President & CEO Kurt Harden at 888-633-2364 or email

New CMS Document Clarifies TKA Removal from Inpatient-Only List

The removal of Total Knee Arthroplasty (TKA) procedures from the CMS inpatient-only list in January 2018 resulted in no small number of provider questions regarding how Medicare would pay for TKA claims under the revised rules. Initial CMS attempts to clarify billing issues served, in some cases, to only muddy things further.

This January, as part of the Medicare Learning Network (MLN), CMS issued “TKA Removal from the Medicare Inpatient-Only (IPO) List and Application of the 2-Midnight Rule.” This document was created with the purpose of explaining what this change means for Medicare providers.

As the document states, the IPO removal “allows Medicare payment to be made to the hospital for TKA procedures regardless of whether a beneficiary is admitted to the hospital as an inpatient or as an outpatient, assuming all other criteria are met.” Additionally, MLN offers examples of TKA cases and the rationale for payment determinations.

MedBen can’t state for certain that this document will clear up every question you may have about TKA claims, but since it appears to be a valid effort to address outstanding questions, we wanted to bring it to your attention.

Now, should you have any TKA questions regarding data reporting, that’s where MedBen Analytics can help. Our work with participants in the Bundled Payments for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) models have given us valuable knowledge about how providers can use bundled payment data to make improvements to patient care while unlocking profit potential.

MedBen Analytics has the solutions to help your organization evolve with the changes in health care payments. Find out more about how you can benefit from our data insights by contacting MedBen President and CEO Kurt Harden at 888-633-2364 or email

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

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

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.


Kurt Harden
President & CEO, MedBen