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Expert Insight into Bundled Payments

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 ccoventry@medben.com.

MedBen Launches Revamped MedBen.com 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 MedBen.com 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 MedBenAnalytics.com 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 ccoventry@medben.com.

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 ccoventry@medben.com.

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 ccoventry@medben.com.

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 ccoventry@medben.com.

 

CMS Announces Release of PY3 Reconciliation Payments for CJR Participants

woman joggingThe Centers for Medicare & Medicaid Services (CMS) announced earlier this month that it expected to release Performance Year 3 (PY3) reconciliation payments for Comprehensive Care for Joint Replacement (CJR) participants on July 25 to hospitals that did not submit an appeal.

If your facility earned a PY3 reconciliation payment and MedBen Analytics performs gainshare distribution services for you, we will calculate the distribution based upon the facility’s collaborator agreement. And if MedBen Analytics doesn’t currently perform this service for you, we’ll take this opportunity to remind you that for an additional fee, we can calculate gainshare distribution for your facility as well.

Please note that CJR gainshare distribution takes place just once every 12 months following each performance year reconciliation (i.e., for 2019, based on episodes that ended on or before December 31, 2018). Additionally, if a facility submitted a Calculation Error (CE) Form to CMS to appeal a finding in the PY3 report, gainshare distribution will be delayed until the appeal process has been finalized.

If you have questions about your PY3 reconciliation payment, or are interested in setting up gainshare calculation and distribution services through MedBen Analytics, please contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or ccoventry@medben.com.

CMS Proposes Radiation Oncology Bundled Payment Model for 2020 Rollout

Senior Female Patient In Hospital Bed & DoctorOn July 10, the Centers for Medicare & Medicaid Services (CMS) announced a new radiation oncology model to be introduced in early 2020. The model proposal states that CMS would make bundled payments to cover 90-day episodes of radiotherapy services for 17 types of cancer based on patient diagnoses. Medicare data would be utilized to assess outcomes compared to the current fee-for-services payment arrangement.

Participation in the 5-year model would be mandatory for radiation oncology providers randomly selected from Core Based Statistical Areas (CBSAs). Payments to participants would be linked to quality metrics, including clinical data reporting and patient experience.

According to the proposal, episode payments would be split into a professional component for physician services and a technical component for equipment, supplies, personnel, and other non-physician costs. This division would acknowledge that professional and technical services are sometimes furnished by separate providers or suppliers.

Assuming the radiation oncology model launches as proposed, participants can expect that the MedBen Analytics platform will be ready to furnish actionable reporting that will help them maximize the value of bundled payments. As we receive more specific information about the model, we will make the necessary additions to our software.

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 Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or ccoventry@medben.com.

MedBen Also Offers Commercial Bundled Payment Services

MedBen BuildingSince 2015, MedBen Analytics has provided bundled payment administration for health systems and hospitals. Now, MedBen third party administration also offers all-inclusive commercial bundled payment services for self-funded employers.

MedBen brings 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.

MedBen Analytics reporting extends to employers as well. We provide self-funded businesses with an online executive dashboard that provides measurable and actionable data. Employers can use the reporting platform to spot risks, study trends and identify opportunities for improving care for plan members.

Hospitals and health systems are among MedBen’s largest blocks of self-funded business, so we have a thorough knowledge of their unique qualities as plan administrators as well as caregivers. We welcome any opportunity to work with providers in our capacity as benefits management specialists.

If you’re interested in learning more about commercial services available through MedBen, we invite you to call our Marketing Department at 888-627-8683. Or if you’d like information specifically about MedBen Analytics software for providers participating in Medicare bundled payment models, contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or ccoventry@medben.com.

MedBen Analytics Client Receives 8th Highest NPRA Payment for CJR PY2

A facility using MedBen Analytics‘ reporting insights received the 8th highest Net Payment Reconciliation Amount (NPRA) for plan year 2 (PY2) of the Comprehensive Care for Joint Replacement (CJR) program, according to Initial Reconciliation numbers recently released by the Centers for Medicare & Medicaid Services (CMS). In addition, three MedBen Analytics clients placed in the top 70 for average NPRA per episode.

Of the 721 facilities on the list, 489 had a positive NPRA and received a reconciliation payment. Participating hospitals earned a total of $93.4 million in payments.

MedBen Analytics continues to help clients maximize value from the CJR bundled payment model. We regularly improve our data reporting platform based on client input that enables all participating providers to benefit from their experience.

We invite you to see for yourself what current MedBen Analytic clients already know. To set up a demonstration of our bundled payment software platform, please contact MedBen Manager of Operations Cari Coventry at 800-423-3151, Ext. 405 or email ccoventry@medben.com.

NOTE: Provider rankings are based upon Initial Reconciliation numbers and may change when CMS releases Final Reconciliation numbers in the coming weeks.

Second Application Period for BPCI Advanced Currently Underway

The application period for the second cohort of participants in the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model is currently open and will close on June 24, 2019. The Centers for Medicare & Medicaid Services (CMS) is accepting applications via the BPCI Advanced Application Portal.

The second cohort of participants will start on January 1, 2020, which is Model Year 3. The BPCI Advanced will consist of 37 bundled clinical episodes – 33 inpatient and four outpatient. Model Year 3 will see the introduction of five new episodes, including outpatient Total Knee Arthroplasty (TKA).

CMS has indicated that is not planning any additional application opportunities for BPCI Advanced… so if you’re interested in participating, this may be your final opportunity to apply. And if you have questions about how bundled payments work, we invite you to request a free demonstration of the MedBen Analytics reporting platform.

MedBen Analytics has been delivering bundled payment insights to health systems since 2015. Whether you’re a current BPCI Advanced participant or plan to apply for the second cohort, we can help your organization realize the most value from bundled payments.

Our knowledge of Medicare data consolidation and analysis will provide you with the information necessary to make improvements through the patient journey while unlocking the profit potential of bundled payments. For additional information or to set up a demo, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email kharden@medben.com.

You can find additional information about BPCI Advanced and the application process by visiting the CMS Innovation Center.