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Bundled Payments Mean Higher Quality, Better Cost, Says Fraker

05/16/16

  08:21:00 pm, by MedBen5   , 316 words,  
Categories: Cost savings, MedBen Analytics, Bundled Payments

Bundled Payments Mean Higher Quality, Better Cost, Says Fraker

Caroline 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.”

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