Expert Insight into Bundled Payments

With MedBen Analytics Reporting, Simplified Data Leads to Valuable Decisions

Whether you are a CEO, CFO, Surgeon or a Clinical Chief of Staff, MedBen Analytics has reports that will give you the insights you need to communicate effectively with your team and make impactful decisions.

Through the MedBen Analytics online portal, clients can access over two dozen distinct reports that enable them to interpret data from multiple perspectives, such as by facility, physician, or net payment reconciliation amount. For example, our Readmissions by MS-DRG report can be used by a decision support team to discuss clinical policy and quality metrics, which leads to improved patient outcomes. Or a CEO can see the broad performance view for one facility or multiple facilities within a system by reviewing our Cost Type Averages Summary.

Reports take seconds to run and the ability to drill down to specific, real-time information helps you find opportunities that affect your business. And all reports are easily exportable into a PowerPoint deck, Word or PDF document, or Excel spreadsheet with one click, allowing you to get the key information you need to communicate to stakeholders quickly and easily.

We invite you to read more about data presentation and some of our most popular reports at the MedBen Analytics website. Or if you’d prefer to see a demo of our reporting platform, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email

BPCI Advanced Features New Incentives, Care Episodes

As we noted in last week’s special insight edition, the Centers for Medicare & Medicaid Services (CMS) will roll out Bundled Payment for Care Improvement (BCPI) Advanced, a new voluntary bundled payment model, on October 1, 2018. Using the current BPCI initiative and other Center for Medicare and Medicaid Innovation (CMMI) models as its foundation, CMS has taken lessons learned from the earlier programs, in addition to provider input, and used them in the development of the Advanced model.

 “BPCI Advanced builds on the earlier success of bundled payment models and is an important step in the move away from fee-for-service and towards paying for value,” CMS Administrator Seema Verma said in a statement. “Under this model, providers will have an incentive to deliver efficient, high-quality care.”

While some of the elements of BPCI Advanced will be familiar to current BPCI participants, CMS has introduced new features to appeal to a greater provider population, as well as offering increased incentives.  Among them:

Advanced APM. To further incentivize providers, BPCI Advanced will qualify 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.

Outpatient Care Episodes. Unlike the earlier BPCI initiative, 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), likely to better focus on those episodes that have demonstrated the greatest provider interest and potential for return.

Applications to participate in BPCI Advanced must be submitted by March 12, 2018 via the CMS Application Portal. If you’re interested in learning more about the new model, the CMS Innovation Center will conduct an hour-long Q&A session on January 30.

MedBen Analytics will be ready to support BPCI Advanced participants with actionable insights beginning with its schedule start this October. In the meantime, 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

CMS Announces New Voluntary Bundled Payment Model; MedBen Analytics Will Provide Data Insights to Participants

On January 9, the Centers for Medicare & Medicaid Services (CMS) formally announced the introduction of Bundled Payments for Care Improvement Advanced (BPCI Advanced), a new voluntary episode payment model. MedBen Analytics, which has provided insightful reporting services for voluntary and mandatory bundled payment models since 2015, will support the new initiative for health systems and providers electing to participate.

BPCI Advanced builds on the foundation of the original BPCI initiative, which began in 2013 and is scheduled to run through September 30, 2018. The new model “aims to support healthcare providers who invest in practice innovation and care redesign, better coordinate care, improve quality of care, and consider the financial implications of their treatment decisions,” CMS said in a press release.

BPCI Advanced will start on October 1, 2018 and run through December 31, 2023. According to CMS, its model design elements include:

  • A voluntary episode payment model that qualifies as an Advanced Alternative Payment Model (Advanced APM);
  • A single payment and risk track with a 90-day post-discharge or post-procedure episode period;
  • 29 inpatient clinical episodes;
  • 3 outpatient clinical episodes;
  • Payment tied to performance on quality measures; and
  • Preliminary Target Prices provided prospectively.

MedBen Analytics will draw on its knowledge of Medicare data consolidation and analysis — backed by 80 years of experience in medical claims management — in the development of software for the BPCI Advanced model, said MedBen President and COO Kurt Harden.

“MedBen Analytics helped our clients thrive under the initial BPCI model,” Harden said. “We anticipate the Advanced model will be a major step forward in value-based care, and look forward to giving participants the insights necessary to achieve success.”

Request for Applications to participate in BPCI Advanced are available at the BPCI Advanced website. CMS says that additional introductory materials will soon be available on the site as well.

MedBen Analytics will provide further information and share observations on the new model as we receive it. In the meantime, 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

A Note from our President: 2018 Offers Optimism, Opportunity 

Happy New Year from the MedBen Analytics team, as well as everyone else at MedBen! I hope that 2018 brings you good health and prosperity.

While MedBen Analytics is a fairly recent addition to our service line, MedBen itself has been around for quite a while… in fact, we’ll be celebrating our 80th anniversary this May. And I believe this blend works to the advantage of our clients – we have the energy that comes with a new offering and decades of experience in medical claims management to guide it.

The past year in value-based care has been, to say the least, interesting. The expectation was that in 2017, we would see the introduction of bundled payment initiatives for cardiac procedures and hip and femur fractures. But following multiple postponements, the Department of Health and Human Services cancelled those programs and scaled back the existing Comprehensive Care for Joint Replacement (CJR) model.

Despite these changes, we enter 2018 excited for the future of value-based care… and for the continued success of MedBen Analytics clients, many of whom received reconciliation payments in 2017.

Although mandatory programs have been reduced, the Centers for Medicare & Medicaid Services (CMS) looks to be expanding the voluntary Bundled Payments for Care Improvement (BPCI) Initiative. While the first phase of this program will end in September, CMS is apparently pleased with the savings to Medicare that BPCI has produced and is expected to announce phase two soon… and I expect that many hospitals and health systems that have been watching from the sidelines so far will be eager to participate in the program.

Ultimately, the success of bundled payment and other alternative payment models rests on the acceptance of those providers who see its potential benefits and willingly invest in value-based care. Our goal is to maximize that value to the advantage of you and your patients with reporting that is both detailed and straightforward, but most importantly offers actionable insights to help you save money while maintaining quality care.

One more thing: We always value your input. If you ever have a comment, question, or suggestion, do not hesitate to call me at 888-633-2364. I look forward to speaking with you in 2018.


Kurt Harden
President & COO, MedBen

Outpatient Arthroplasty Provision Requires Team Strategy

The Medicare hospital outpatient prospective payment system (OPPS) final rule includes something that will have a direct bearing on the Bundled Payment for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) models: a provision that removes total knee arthroplasty from the inpatient-only list beginning in January 2018.

The broadening of how Medicare will reimburse the procedure raises the question of how it will affect bundled payments – specifically, whether or not a potential shift of younger, healthier patients choosing the outpatient option will skew BPCI and CJR outcomes.

In the final rule, the Centers for Medicare & Medicaid Services (CMS) stresses that while it does not expect a “significant volume” of total knee arthroplasty cases to switch to outpatient treatment, it will monitor the situation and make adjustments if necessary. But the bottom line is, no one knows for certain the effect the provision will have on model pricing.

What we do know for sure is that the change will affect the decision-making that goes into which patients are better suited for outpatient treatment and which will best benefit from a longer hospital stay. Toward that goal, the smart strategy right now is for your administrative and clinical teams to evaluate the possible impact to reimbursement, pre-certification, and patient care and prepare accordingly, making process changes where necessary.

When CMS finalizes the model changes, MedBen Analytics will offer further insights. In the meantime, if you wish to share your own thoughts about the OPPS outpatient arthroplasty provision, you can contact CMS no later than 5 p.m. EST on December 31, 2017. Electronic comments are preferred, but you can also submit your comments by regular mail, express/overnight mail, or hand/courier. The OPPS rule provides detailed submission instructions beginning on page 2.

Getting into the “Pre-habit” Pays Dividends

In recent CMS webinars that allow physicians and nurse navigators to talk about the things that work to maximize positive returns from the Comprehensive Care for Joint Replacement (CJR) program, the topic of “pre-hab” has cropped up on multiple occasions.

Encouraging pre-hab – that is, preparing the patient for recovery prior to surgery through regular exercise – produces lower care costs for providers and promotes faster recoveries and fewer complications for patients.

Certainly, patients benefit physically and mentally from working out, and the incentive to leave the hospital sooner post-surgery appeals to most people. But providers benefit as well, and not only in regard to cost considerations. As pre-hab typically incorporates onsite educational classes, members of the CJR team are afforded the chance to see the patient “in action” pre-surgery… to gauge level of mobility, learn more about the patient’s home life, and suggest exercises that are appropriate to the patient’s unique needs.

Patient pre-hab requires a small investment of time and resources, but based on the feedback MedBen Analytics has received – not to mention, client representation on the recent CMS reconciliation list – our impression is that the extra effort pays off nicely in the long term.

MedBen Analytics clients who would like to share their thoughts on pre-hab and other ways to get the best returns from bundled payments are encouraged to contact MedBen President & COO Kurt Harden at 888-633-2364 or email

CMS Final Rule Slows (But Doesn’t Stop) Bundled Payment Growth 

We pretty much knew it was coming, but on November 30 the Centers for Medicare and Medicaid Services (CMS) finalized its decision to cancel mandatory hip fracture and cardiac bundled payments scheduled to go into effect January 1, 2018. CMS also reduced the number of mandatory Comprehensive Care for Joint Replacement (CJR) Model participants on a mandatory basis from 67 to 34.

In spite of the final rules, CMS Administrator Seema Verma says the agency is still confident that value-based care can improve quality and lower costs. “We believe that focusing on developing different bundled payment models and engaging more providers is the best way to drive health system change while minimizing burden and maintaining access to care. We anticipate announcing new voluntary payment bundles soon,” Verma said in a press release.

While these changes will likely slow the growth of bundled payments as an alternative to the fee-for-service model, 2017 has seen positive development that bode well for the future of value-based care. Studies released earlier this year demonstrate that value-based programs lower costs and episode volume and reduce hospital readmissions. And in October, results for the first year of the CJR program showed that participating hospitals earned $37.6 million in reconciliation payments – with nearly half of MedBen Analytics clients receiving the payments.

“During the past year, we’ve witnessed first-hand the effectiveness of the bundled payment model,” said Kurt Harden, President and COO of MedBen Analytics. “Costs for our clients have gone down with no adverse affect in customer satisfaction. Even with a scaled-back CJR model, we expect to see further positive developments in 2018.”

Whatever changes may lie ahead for bundled payments, MedBen Analytics will continue to give providers the insights they need to improve performance and benefit from value-based care. If you ever have questions about how our services can help your business, please call Harden at 888-633-2364 or email

MedBen Analytics Clients Well-Represented on CJR Results List

Last week, the Centers for Medicare & Medicaid Services (CMS) released preliminary results for the first year of the Comprehensive Care for Joint Replacement (CJR) program, which revealed that participating hospitals earned $37.6 million in reconciliation payments.

MedBen Analytics had strong client representation on the payment list, including a top 30 earner and a top 50 earner. In all, nearly 50% of MedBen Analytics clients received payments after the first year of the CJR program.

MedBen Analytics 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. The MedBen Analytics unique portal approach has been popular with users who can quickly access and explore variations in the cost of care at all points in the episode.

As participating hospitals have gained knowledge from the first year of CJR, so too has MedBen Analytics. The feedback received from our clients has enabled us to make regular changes to our software, offering providers even greater scope and depth in reporting options. These improvements will help hospitals to build on their efforts in year two.

We invite you to see for yourself what current MedBen Analytic clients already know. To set up a demonstration of our reporting platform, please contact MedBen President & COO Kurt Harden at 888-633-2364 or email

Continued CJR Participation for Voluntary Health Systems Requires Informing CMS

Last month, the Centers for Medicare and Medicaid Services (CMS) proposed changes to the Comprehensive Care for Joint Replacement (CJR) program that would in 2018 reduce the number of health systems mandatorily participating from 67 metropolitan statistical areas (MSAs) to 34. Those systems no longer required to participate in CJR will have the option to continue with the program on a voluntary basis – but to do so will require informing CMS during a one-month election participation period in early 2018.

Under the proposal, the health systems in the 34 MSAs designated as Mandatory Participation MSAs will still be required to participate in 2018, except for rural and low-volume hospitals in those areas that may continue to participate on a voluntary basis. “Low volume hospitals” are those identified by CMS as having fewer than 20 CJR episodes in total across the three historical years of data.

The 33 MSAs no longer required to participate are designated by CMS as Voluntary Participation MSAs, and may also continue with the program if they so choose.

From January 1 to January 31, 2018, CMS proposed a participation election period in which health systems that wish to voluntarily continue with CJR must complete a participation election letter. Voluntary participation would be effective February 1, 2018, and continue through the end of the CJR model. No participation election letter is required for those health systems located in a Mandatory Participation MSA.

MedBen Analytics will continue to provide actionable insights for all CJR participants, mandatory and voluntary alike. If you’re interested in a demonstration of our reporting platform or additional information, please contact MedBen President & COO Kurt Harden at 888-633-2364 or email

For MedBen, Your Data Security Is an Ongoing Commitment

No business is more acutely aware of the importance of data security nowadays than those in the health care industry. With ransomware becoming more prevalent, the need for heightened measures has never been greater… and for years, MedBen has been addressing this need.

Long before “cybersecurity” became common language, MedBen had gone to great lengths to ensure the safety of client information. So when we introduced our MedBen Analytics platform in 2015, we already had in place the resources which would protect the transfer of provider data from CMS to MedBen Analytics, and allow it to be accessed and viewed only by authorized users.

MedBen approaches security from three perspectives: external, internal, and physical. In all three instances, we continue to add new safeguards to our existing protections.

But having these safeguards in place is only half the story. Our cybersecurity strategy requires that we test these protective measures through periodic, unscheduled penetration attempts by IBM and other outside firms. Not only do these tests confirm the reliability of our safeguards, they provide valuable feedback that helps us further strengthen our defenses.

MedBen Analytics clients with questions regarding our cybersecurity measures are welcome to contact our Vice President of Information Systems and Chief Privacy Office Rose McEntire at