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Expert Insight into Bundled PaymentsBlog Categories
80 Years Experience Makes the Difference
MedBen Analytics may have launched in 2015, but MedBen itself – and the health benefits services we administer – go back quite a way. Nearly eighty years, in fact.
MedBen started life in 1938 as a hospital services association. So when we created the MedBen Analytics software platform, we brought more to the table than just the technical know-how to convert bundled payment data into clear reports. Our extensive claims management experience gives us a unique perspective that enables us to take data analysis to the next level – providing practical insights health systems can use to make informed decisions.
Closely tied to this experience is the skill of the MedBen staff. The core team behind MedBen Analytics have worked for the company an average of 22 years, and their combined expertise ensures that clients have the tools needed to uncover inefficiencies and make improvements.
Customer service plays an important role, too. In the weeks leading up to the recent deadline to appeal CJR Performance Year 1 Reconcilation reports, MedBen aided clients in identifying calculation errors and submitting forms. An e-mail from a hospital representative commended MedBen Manager of Operations Cari Coventry for spending “quite a bit of time with me and the cadre of hospital team leads, helping us to appropriately leverage MedBen’s reports and to demystify the CMS reconciliation process.”
Company experience, team expertise, and customer service… all part of what how MedBen Analytics makes bundled payments work for you. Learn more by contacting MedBen President & COO Kurt Harden at 888-633-2364 or email kharden@medben.com.
Bundled Payments: Preferences & Potential Gains
“Is The Debate Over Retrospective Versus Prospective Bundled Payments A Distraction?” asks a recent article on the Health Affairs Blog. In essence, the argument goes, is the prospective approach of the facility receiving a single check from Centers for Medicare & Medicaid Services (CMS) for payment distribution preferable to the retrospective approach of CMS cutting checks for every claim that is included in the bundle?
MedBen Analytics administers both prospective and retrospective bundles for facilities participating in multiple CMS models… and we can say that, based on our experience, both payment approaches can be equally effective in care redesign, elevating quality and patient outcomes. Ultimately, it comes down to whichever approach the facility prefers.
One opportunity to reinforce coordination of care and high-quality patient outcomes that the article doesn’t touch on – and, we think, a critical one – is gainsharing, which MedBen Analytics also administers. Gainsharing allows the facility to share gains with collaborators (surgeons and post-acute care providers) who participate in care redesign and provide high-quality care to eligible Medicare beneficiaries.
MedBen Analytics is designed with the express purpose of maximizing the value of care provided to patients by decreasing ineffective costly care 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 MedBen President & COO Kurt Harden at 888-633-2364 or email kharden@medben.com.
Data Insight Key to Bundled Payment Efficiency, Say Harden at Summit
“If the data is there, we can rebuild it,” said MedBen President & COO Kurt Harden at the Seventh National Bundled Payment Summit in Arlington, Virginia on June 27.
Speaking on the topic of how health systems and hospitals can make bundled payments work to their best medical and financial advantage, Harden said that these value-based programs “have given providers critical data to improve care and cost, if the data is properly deployed.”
By taking disparate Medicaid data and transforming it into practical insights, MedBen Analytics is designed to give health care providers clear information that helps them to uncover inefficiencies and make improvements to the delivery of patient care, from surgery through post-acute.
Harden also demonstrated MedBen Analytics’ drill-down functionality that enables users to review care from the system level all the way to individual services. “And there is no additional charge for extra users,” Harden noted.
Harden attended the summit with Wendell Crain, Director of Security, Infrastructure and Web Development for MedBen Analytics.
Organizations interested in discussing MedBen Analytics’ services can call Harden at 888-633-2364 or email him at kharden@medben.com.
Data Insight Key to Bundled Payment Efficiency, Say Harden at Summit
“If the data is there, we can rebuild it,” said MedBen President & COO Kurt Harden at the Seventh National Bundled Payment Summit in Arlington, Virginia on June 27.
Speaking on the topic of how health systems and hospitals can make bundled payments work to their best medical and financial advantage, Harden said that these value-based programs “have given providers critical data to improve care and cost, if the data is properly deployed.”
By taking disparate Medicaid data and transforming it into practical insights, MedBen Analytics is designed to give health care providers clear information that helps them to uncover inefficiencies and make improvements to the delivery of patient care, from surgery through post-acute.
Harden also demonstrated MedBen Analytics’ drill-down functionality that enables users to review care from the system level all the way to individual services. “And there is no additional charge for extra users,” Harden noted.
Harden attended the summit with Wendell Crain, Director of Security, Infrastructure and Web Development for MedBen Analytics.
Organizations interested in discussing MedBen Analytics’ services can call Harden at 888-633-2364 or email him at kharden@medben.com.
MedBen Analytics Offers Gainshare Distribution Services
In addition to providing insights to help health systems improve their performance under the bundled payment models, MedBen Analytics also offers Comprehensive Care for Joint Replacement (CJR) gainshare distribution services. For an additional fee, we can administer the allocation of profits resulting from high-quality, cost-effective care between the hospital and its collaborators.
If your facility earned a Performance Year 1 (PY1) reconciliation payment from the Centers for Medicare and Medicaid Services (CMS), MedBen Analytics will calculate the gainshare distribution based upon the facility’s collaborator agreement and disperse funds to eligible collaborators.
Please note that CJR gainshare distribution takes place just once every 12 months following each performance year reconciliation (i.e., for 2017, based on episodes that ended on or before December 31, 2016). Additionally, if a facility submitted a Calculation Error (CE) Form to CMS to appeal a finding in the PY1 report, gainshare distribution will be delayed until the appeal process has been finalized.
To set up gainshare calculation and distribution services or for additional information, please contact MedBen President & COO Kurt Harden at 888-633-2364 or email medbenanalytics@medben.com.
With Readmissions, Cost Savings Are in the Details
Among the advantages of MedBen Analytics’ proprietary reporting platform is that it allows providers to drill down into hospital readmission data. Now, a new study demonstrates the financial value of this accessibility.
University of Michigan researchers have found that hospitals participating in bundled payment and other value-based programs have lower readmission rates than those that use fee-for-service alone. From 2005 to 2015, program participants saw a 2.9% reduction in readmissions each year for heart failure patients, as well as 2% drop for heart attack and a 1.9% decrease for pneumonia.
With MedBen Analytics, hospitals have the ability to review readmission details – even those that occurred at different hospitals – and compare current episodes with benchmark data. Using this information, providers can evaluate readmission activity, analyze their underlying causes, and make changes as needed.
MedBen Analytics delivers insights on readmissions, lengths of stay and other cost-oriented variables, enabling hospitals to make informed care decisions. Learn more by contacting MedBen President and COO Kurt Harden at 888-633-2364 or kharden@medben.com.
CJR Year 1 Reconciliation Reports Available
Earlier today, CMS delivered the Comprehensive Care for Joint Replacement (CJR) Performance Year 1 (PY1) Reconciliation Reports and related files. MedBen Analytics has begun the process of auditing the Net Payment Reconciliation Amount (NPRA) for our clients.
A hospital will earn a positive NPRA if the aggregate capped episode cost for PY1 (episodes ending on or before 12/31/2016) is less than the aggregate target price and the composite quality score was Acceptable Good or Excellent.
The CMS CJR Reconciliation: Performance Year 1 reports will be sent to our clients via secure email today. Clients with questions regarding these reports may contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or ccoventry@medben.com.
In Claims Analysis, Experience Makes the Difference
The rise of alternative payment models has, naturally, brought with it a number of services designed to assist providers in the difficult task of using the data made available by CMS as part of the bundled payment programs. Interpreted properly, this data can make the difference between success and failure under the program.
In addition to the fact that the MedBen Analytics reporting platform offers variety, ease of use and drill-down functionality, we possess an advantage that few others can cite: Detailed claims analysis based on nearly 80 years of health care and benefits administration experience.
From our start as a Hospital Services Association in 1938, MedBen has made a business of working with health care systems, hospitals and physicians. Since 1990, we’ve carved out a niche as a third party administrator, offering innovative solutions for health care systems and their employee benefits plans. And today, we work with health care systems to develop bundled payment solutions, drawing upon our expertise to provide unique insights.
Claims analysis goes beyond data sorting – MedBen Analytics offers a level of reporting than only decades of experience can provide. If you’re interested in a demonstration of our system or additional information, please contact MedBen President & COO Kurt Harden at 888-633-2364 or email medbenanalytics@medben.com.
CJR Claim Data Feeds Go Monthly
CMS recently announced that, beginning this month, they will switch from quarterly data feeds to monthly data feeds for CJR. For MedBen Analytics clients, this means reporting in our portal will be even more current, allowing them to follow a patient’s care path within about one month of the provided service.
Once the switch to monthly data has been implemented, it will be immediately integrated into your MedBen Analytics reports, with no additional action needed on your end.
Naturally, the thoroughness of information available will be based upon the timely filing of claims by the provider… if the filing process is delayed, the reports may not reflect all claims activity for the period selected.
Additionally, CMS and Mathematica are in the process of revising the methodology to impute standardized payments. This calculation correction, and the related specification document, is scheduled to be delivered in the March 2017 data feed.
As MedBen Analytics is designed to help providers make decisions based on the most complete and up-to-date information available, we’re pleased that CMS has made this change. If you have any questions about the switch to monthly production or our reporting portal, please call MedBen President & COO Kurt Harden at 888-633-2364 or email medbenanalytics@medben.com.
Value-Based Payment Model Gaining Steam with Providers, Employers
Half of health care systems now accept value-based reimbursements, and that number may go even higher in the next few years, a new survey suggests. MedBen has seen firsthand the potential of alternative payments to benefit self-funded employers and providers alike, and is helping clients realize that potential.
According to Modern Healthcare, 36% of respondents to the KPMG survey said they receive some reimbursement from value-based contracts, while 14% said they get most of their payments that way. Another 26% said they are planning to enter value-based payment arrangements in the next one to three years.
These findings indicate that health care systems are responding to the growing popularity of alternative payment methods in the private and public sectors. Last year, an analysis by the National Business Group on Health revealed that nearly half of self-funded employers have incorporated some type of value-based design in their health care plan. Likewise, the Centers for Medicare & Medicaid Services expect that by 2018, half of all provider payments from Medicare will be via “alternative models.”
Through our MedBen Analytics service, which helps hospitals convert raw Medicare data into actionable insights, we’ve seen how value-based payments enable providers to make informed choices necessary to improve services. This arrangement will also benefit self-funded plans, who will realize lower costs than fee-for-service payments without compromising quality of care.
We are rolling out commercial bundled payment services to clients. As health care systems become more comfortable with the value-based model, MedBen expects it to become the norm for employer claim payments.