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Study: Bundled Payment Model Saves Money, Maintains Quality Care
Proper use of bundled payments by health care providers can save money while maintaining or even improving quality of care, concludes new research from the Perelman School of Medicine at the University of Pennsylvania.
According to a Penn Medicine news release, the evaluation of costs and care quality for hip and knee replacements performed from 2008-2015 at a Texas-based health system determined that the average cost per patient dropped nearly 21% during that period. The health system began the transition from fee-for-service to bundled payments in 2009.
The study also found a 67% drop in extended hospital stays, while the severity of patient conditions remained unchanged.
As these numbers suggest, the steady growth of alternative payment models carries the potential for significant cost savings in the delivery of health care. MedBen Analytics is working to help hospitals, health systems, and physician groups fulfill that potential.
Through our proprietary reporting platform that converts disparate Medicare data into actionable insights, MedBen Analytics enables providers participating in the Comprehensive Care for Joint Replacement (CJR) and other value based payment initiatives to make informed decisions regarding hospital readmissions, lengths of stay and other cost-oriented variables.
As methods from bundled payments for hip and knee replacements are being applied to cardiac care and other medical procedures, MedBen Analytics continues to broaden its reporting platform. Our goal is to ensure that providers get full advantage of the data transparency now available to them, and use our reports to offer optimal service while saving money ‒ and enhancing their reputations.
Organizations interested in discussing MedBen Analytics’ services can call President and COO Kurt Harden at 888-633-2364 or email him at kharden@medben.com.
Value-based Care Will Thrive Regardless of ACA’s Future
While the recent election has created much uncertainty about the future of the Affordable Care Act (ACA), there’s a strong likelihood that a number of its individual provisions will survive in one form or another ‒ among them, the push to switch from a fee-for-service provider payment model to one centered around value-based care.
Kevin Kennedy of ECG Management Consultants suggests 10 reasons why value-based care will continue to thrive in the Trump Administration. You can read the entire list at the ECG website, but we’ll highlight a few of his thoughts below:
We need to get costs under control, and the same fee-for-service model isn’t going to get us there. According to the Department of Health & Human Services, healthcare spending could climb to $3.35 trillion by the end of 2016. That equates to $10,345 for every American, which dwarfs the per capita healthcare spending of every other industrialized nation.
Many employers have already made up their minds about value-based care. In an effort to keep their employees healthier and curb premium costs, employers are increasingly collaborating with health insurers and medical service providers to design value-based reimbursement arrangements
Healthcare consumers want value. As in other industries, consumers want to know that there is value in the services they are purchasing, be that in the form of cost, quality, convenience, experience, or a combination. Consumerism is not a partisan issue.
Kennedy also mentions that “… innovation has been unleashed on the healthcare industry” ‒ and here’s where MedBen Analytics comes in. We provide an innovative platform with which hospitals can best capitalize from bundled payments for value-based care.
MedBen Analytics’ advanced reporting system takes raw claims data and converts it into actionable reports. Using the insights offered, providers can see where opportunities for improvement lie. And while the initial focus for our platform is on Medicare payments, its cost-saving applications have the potential to benefit the private sector as well.
Hospitals and providers interested in a demonstration of the MedBen Analytics system or additional information are welcome to contact MedBen President and COO at 888-633-2364 or kharden@medben.com.
Clear Analytics Key to CJR Savings, Says Harden at Conference
“Keep analytics clear, simple, and interactive in order to deliver effective care transformation messages.” That was the message Kurt Harden, President and Chief Operating Officer of MedBen Analytics, delivered to hospitals, health systems, and consultants at a recent national conference for the newest iteration of the Centers for Medicare and Medicaid value-based payment initiative known as the Comprehensive Care for Joint Replacement (CJR).
Harden spoke at the CJR Boot Camp held in Miami, Florida on September 24th and 25th, talking with participants about the use of analytics to guide care transformation. “There is very good information available about how health systems across the country have saved money in lower joint replacements. Build analytics with this knowledge in mind,” he said.
CJR is mandated in 67 markets across the United States, and affects over 800 health systems performing lower joint replacements for Medicare recipients. MedBen Analytics performs data analytics services for hospitals participating in the CJR program, turning Medicare claim data under the program into care improvement insights.
In his comments, Harden encouraged participants to keep care transformation analytics focused on key cost-saving areas and avoid being distracting by “interesting but unactionable” data. He also gave examples from MedBen’s proprietary analytics portal, showing how to mine the Medicare claims data for savings opportunities in the CMS value-based care initiatives.
“The post-acute setting is rich with savings potential,” Harden observed. “Skilled nursing care, readmissions, even home health care costs should be monitored closely.”
MedBen Analytics is a subsidiary of MedBen Administrators and provides analytics services for health systems across the country. Organizations interested in discussing MedBen Analytics can call Harden at 888-633-2364 or email him at kharden@medben.com.
Bundled Payments Rising, Hospital Readmissions Dropping
As bundled payments and other alternative payment methods become more commonplace, hospital readmission rates and costs are dropping. MedBen Analytics has been working to ensure that hospitals realize the benefits of bundled payments ‒ benefits that will ultimately carry over to commercial health plans as well.
From HealthLeaders Media: “From 2007 to 2011, the all-cause 30-day hospital readmission rate for Medicare fee-for-service beneficiaries held steady at about 19% to 19.5%, according to the Centers for Medicare & Medicaid Services. But those rates fell to 18.5% in 2012 and 17.5% in 2013, CMS reports.”
MedBen Analytics is helping hospitals make the transition to value based payments, through an advanced reporting system that takes raw Medicare claims data and converts it into actionable reports. Using the insights offered, providers can make informed choices necessary to improve services.
When hospitals can see where opportunities for improvement lie, they benefit from higher returns on bundled payments. Patients and health plans benefit, too… from more focused care and lower costs.
Organizations interested in a demonstration of the MedBen Analytics system or additional information are welcome to contact MedBen President and COO at 888-633-2364 or kharden@medben.com.
MedBen Analytics Converts Data to Insight, Harden Says at Bundled Payment Summit
MedBen President and COO Kurt Harden was among the presenters at the Sixth National Bundled Payment Summit in Washington, DC on June 9. Speaking at the event’s Innovation Showcase, Harden discussed Comprehensive Care for Joint Replacement (CCJR) bundled payment solutions developed by MedBen Analytics, the company’s value based payment administration service.
“Hospitals are drowning in data and starving for insight,” Harden said. ” MedBen Analytics works very hard to take that enormous amount of raw data, draw out insights. We provide it to clients so they can make informed choices.”
During his presentation, Harden showed examples from MedBen Analytics’ portal-based reporting system, highlighting its drill-down functionality. “We focus on the data so our clients can focus on decisions. All they have to do is log in and look at the reports,” he said.
Harden also noted that because MedBen has decades of experience at third party administration, that knowledge was a key advantage in developing the MedBen Analytics platform. “Our system design ensures accurate bundled payment parameters, in part because we assume nothing about the group. Rather, the reporting is based solely on the specific needs of the hospital.”
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.
Bundled Payments Mean Higher Quality, Better Cost, Says Fraker
Bundled payments and other alternative payment methods already popular for Medicare claims will soon be used by commercial group health plans to save money while promoting quality care, says MedBen Vice President of Compliance Caroline Fraker.
In a recent article published by the Society of Professional Benefit Administrators (SPBA) and directed at third party administrators (TPAs), Fraker noted that while bundled payments are currently used primarily for Medicare patients, as their advantages over the traditional fee-for-service model become better understood, the quality-focused approach will eventually become the norm for claims administration to self-funded plans as well.
“The benefits of these alternative payment models are clear — increases in quality of care, decreases in lengths of stay and readmission and the realignment of inpatient and post-acute care,” Fraker writes. “And as these hospitals […] experience how these benefits affect their bottom line, they will seek to apply these same cost-saving, quality-improving methods to their commercial payor models. It is happening already.”
Fraker goes on to observe that as the transition to quality-based payment models progresses, TPAs like MedBen will play an important role in helping hospitals through specialized claims data tracking and analysis. MedBen already provides analytics and processing services for providers participating in the Medicare programs, known as Bundled Payment Care Initiatives (BPCI), and hospitals who are part of a larger mandatory bundle program for lower joint replacements – Comprehensive Care for Joint Replacement (CJR).
At MedBen, we can use our proven benefits administration expertise in a variety of areas, from reconciling different plan designs to employee engagement issues and employer strategies. And ultimately, the benefits from the smart use of bundled payments will translate to lower plan costs for employer and employee alike.
In her concluding comments, Fraker writes: “[The Centers for Medicare & Medicaid Services] and [Capability Maturity Model Integration] are handing us the keys to the future of claims payment. Go ahead and unlock the door.”
MedBen Analytics Ready to Help Hospitals with Bundled Payment Solutions
April 1 marked an important day for U.S. hospitals, as Medicare makes a major shift from fee-for-service medicine to value based payments in 67 metropolitan statistical areas (MSAs) across the country. MedBen Analytics has an innovative system in place to assist participants with the transition.
With the introduction of mandatory bundled payments for Medicare knee and hip replacements, selected hospitals will be accountable for the quality as well as the costs of care from the start of the surgery through 90 days post-discharge.
For nearly two years, MedBen Analytics has been working to provide a bundled payment analysis and reporting program that turns Medicare claims data into actionable insights necessary to improve services. Our current hospital clients are already realizing the benefits of our analytics engine, by using the reports to see where opportunities for improvement lie and modifying their clinical pathways accordingly.
MedBen Analytics will be participating in the Sixth National Bundled Payment Summit on June 7-9, 2016 at the Grand Hyatt in Washington, DC. If you plan on attending this event, we encourage you to stop by and say hello.
For a demonstration of our system or additional information, please contact MedBen President and COO Kurt Harden at 888-633-2364 or kharden@medben.com.
Read more about the mandatory bundled payment rollout at Forbes.com.
As Providers Shift to Value-based Payments, MedBen Analytics Offers Actionable Insights
The U.S. Department of Health and Human Services (HHS) is taking bold measures to move Medicare payments from the traditional model to alternatives based on the value of the services given. MedBen Analytics is currently working with providers nationwide to help them make this transition in a performance-efficient and cost-effective manner.
At the World Economic Forum Annual Meeting in Switzerland last month, Secretary Sylvia M. Burwell said HHS will meet their goal of moving 30% of fee-for-service Medicare payments to bundled payments and other value-based arrangements by year end. The agency has also set the goal of tying 50% of Medicare payments to alternative payment models by the end of 2018, Healthcare Dive reports.
HHS states that the use of alternative payment models has:
Saved Medicare a combined $417 million;
Reduced hospital readmissions in Medicare by nearly 8%; and
Through quality improvements, saved 50,000 lives and $12 billion in care spending from 2010 to 2013.
As bundled payments and other value-based payment models become more commonplace, and an ever-greater number of older Americans become eligible for Medicare, providers need to have the tools required to make informed decisions about the delivery of care. Toward this goal, MedBen Analytics turns claims data into actionable insights necessary to improve performance.
MedBen Analytics’ proprietary analytics software takes the numerous and disparate Medicare files available to bundled payment initiative hospitals, health systems and physician practice participants and creates straightforward, interactive reports to benefit the provider of care as well as the recipient.
Organizations interested in discussing MedBen Analytics’ services can call President and COO Kurt Harden at 888-633-2364 or email him at kharden@medben.com.
Data Transparency Leads to Success in Bundled Payments, Harden Says at Conference
“Data transparency will help drive success in the new world of value-based and bundled payments.” That’s the message MedBen President and COO Kurt Harden shared with hospital, health system, and provider group representatives at the 2nd Annual Bundled Payment Implementation Forum on January 25.
“The old world of health payments has been about delayed, withheld, filtered, and segmented information,” Harden told conference attendees. “The new world will need more on-demand, widely dispersed, useful, and comprehensive data use.”
Bundled Payments
Harden was among the featured speakers at the conference, which offered professional perspectives on bundled payments, an increasingly common form of provider compensation.
As the Centers for Medicare and Medicaid Services (CMS) move away from a fee-for-service reimbursement model, a variety of alternative reimbursement models are being implemented. CMS Director, Sylvia Burwell says that 90% of the CMS payments will be in the form of alternate payments by 2018 – among them, bundled payments.
In a bundled payments model, hospitals, health systems, and providers are incentivized to meet payment targets for entire episodes of care. For example, the payment for a hip or knee replacement would cover all elements of the procedure, including the hospital stay, replacement joint, physician charges, anesthesia, most medications, and care for up to 90 days following discharge from the hospital.
Early indications from a variety of nationwide tests on this approach have shown success in controlling costs and improving outcomes for patients. As a result of those successes, CMS announced a mandatory lower joint replacement bundle to be implemented in 67 markets across the U.S. This mandatory bundle, known as the Comprehensive Care for Joint Replacement model, or CJR, will affect over 800 hospitals nationwide who perform lower joint replacements on Medicare recipients.
“Start with the end in mind”
“When outlining your data needs for bundled payments, it is best to start where health systems have seen the most success controlling costs,” Harden explained to conference participants. “Bundled payments bring a rich new source of longitudinal data on medical care and associated costs.”
Providers will want to focus on information that will help them succeed in this new payment world, Harden observed. “Look at data on length of stay variations, post-acute care settings, readmissions, and supply costs. Organizations that have been successful with bundled have used this information to improve clinical pathways to lower costs and improve care,” he said.
Harden sees this work as benefitting all MedBen clients. “These alternative payments methods will continue to grow in all areas of health care financing,” he emphasized. “Our analytics team is using the knowledge we gain from this new line of business to help innovate new savings approaches for all of our clients.”
MedBen Analytics
In 2015 MedBen formed a new subsidiary, MedBen Analytics, dedicated to using Medicare claims data to provide clients with highly actionable insights necessary to improve care. MedBen Analytics saves clients money by using a proprietary analytics engine that delivers information quickly and effectively, via an online portal in easy-to-understand and interactive reports.
For example, one MedBen client used the MedBen Analytics skilled nursing report to detect an overutilization issue. The client modified their clinical pathway and saved nearly $500,000 on lower joint replacements.
Harden can be reached at kharden@medben.com.
MedBen Analytics Bundled Payment Webinars Offer Final Rule Analysis, Practical Advice
Last month, MedBen Analytics offered several bundled payment webinars to hospital administrators whose facilities will soon take part in a mandatory Comprehensive Care for Joint Replacement (CJR) program. The presentation from December 17 is now available for viewing at the MedBen Analytics YouTube page.
Entitled “Understanding the Final Rules: Comprehensive Care for Joint Replacement,” the webinar offers attendees an overview of value-based payments and a professional analysis of the CJR rules. The Centers for Medicare and Medicaid Services (CMS) will start the mandatory CJR program for selected health systems in April 2016.
Additionally, webinar co-presenters Kurt Harden, President and COO of MedBen Analytics, and Kimberly Hartsfield, Vice President of GE Healthcare Camden Group discuss practical next steps for best ensuring success in the CJR and insights for key savings opportunities. Attendees also are given an opportunity to assess hospital-specific historic performance.
MedBen Analytics will be conducting additional bundled payment webinars throughout 2016. Hospital, health system and physician group administrators who would like to be added to the webinar invite list are welcome to contact MedBen Sales Analyst Sally Wood at swood@medben.com.
Administrators that are interested in an analysis based on the lower joint replacement services using the Medicare Limited Data Sets for 2014 are welcome to contact Harden at 888-633-2364 or kharden@medben.com.