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 email@example.com.
The New York Times reports that approximately 125,000 deaths and at least 10% of hospitalizations can be attributed to lack of prescription adherence. From a financial perspective, negligence costs the American health care system between $100 billion and $289 billion a year.
“Studies have consistently shown that 20% to 30% of medication are never filled, and that approximately 50% of medications for chronic disease are not taken as prescribed,” according to a review of research in Annals of Internal Medicine. Those who do take medications take only about half the prescribed doses, regardless of their condition's severity.
These numbers demonstrate that, simply by following doctor's orders, patients can better control their condition, or cure it altogether. And they'll likely save money by doing so.
MedBen works with clients to bolster prescription adherence through a variety of measures, such as strategic pharmacy plan design with an emphasis on lower-cost generic alternatives, and incentives to encourage population health through our WellLiving program. Closely tied to this is emphasizing to plan members the importance of maintaining a relationship with their family doctors, which promotes personal accountability in addition to preventive care.
Learn more about the ways MedBen can help your business foster a healthier workforce by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Two cancer screening-related items recently made the news, both of which address the question of when (or if) such tests are appropriate:
The U.S. Preventive Services Task Force (USPSTF) has walked back from its 2012 position that most men should forego a screening for prostate cancer, then claiming that its risks outweigh any benefits. In an April 11 draft recommendation, the panel says now states that “the decision about whether to be screened for prostate cancer should be an individual one,” and that men between the ages of 55 and 69 should discuss the pro and cons with their physician and make decisions based on their own values and preferences.
The USPSTF's revised guidance concurs with what the American Cancer Society (ACS) and MedBen WellLiving recommends: Men age 50 and above (or younger, in cases of high risk) should talk to their family doctors to determine if prostate screening is right for them.
Another USPSTF decision that has engendered a fair amount of debate is its recommendation that women without a family history of breast cancer wait until age 50 to have a yearly mammogram. But a new survey found that 81% of responding physicians believe that breast cancer screenings for women should begin at age 40, and 88% say screenings should start no later than 45.
MedBen WellLiving also recommends annual mammograms for women age 40 and over, while ACS screening guidelines encourage personalized screening decisions for women ages 40 to 44, with routine mammograms starting at 45.
High cost claimants are among the leading contributors to health care spending, topping even medical inflation, pharmaceuticals and specific diseases. A study from the American Health Policy Institute and Leavitt Partners found that claimants who cost $50,000 or more in a year are the top cost driver for 43% of large employers, and comprise 31% of total spending among employers’ health plans. On average, a high-cost claimant costs an employer about $122,000 annually.
Recognizing that plan members sometimes require high-priced treatment, MedBen has multiple means to keep claim costs in check with self-funded plans. The first step is to make sure the plan isn’t paying for services it shouldn’t be. With large claims, there is higher risk of paying for something that is not medically necessary or inappropriate. A self-funded plan has the latitude to manage claim costs by customizing the review of particular types of claims. MedBen can flag claims requiring clinical review by using dedicated surveillance software that triggers the specialized medical review of claims before payment is made to the health care provider.
MedBen has found that using a panel of over 125 board-certified medical specialists is key to the claims management approach. Reviewing claims flagged for potential clinical questions or problems, they work with the provider to reach a proper resolution ‒ all before the plan pays the provider, so employers don’t have to recoup expenses later. Using this method of claim review, MedBen saves an average of 26.5% on all clinically reviewed claims and in 2016 saved its clients an average of $9.75 per covered employee per month. That’s money the health plan can use to provide other benefits to its employees.
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 email@example.com.
At the 15th Annual MedBen Hospital Roundtable, MedBen President and COO Kurt Harden and Vice President of Sales & Marketing Brian Fargus shared with attendees a wealth of information about their medical and pharmacy plans, including how their costs compared other hospitals and strategies to maintain low cost trends. Below we highlight a few of their observations:
Again, this makes up only a small portion of the useful information offered at the Hospital Roundtable. And incidentally, non-hospital groups will soon have an opportunity to see how their company compares with other businesses in their size range, and get money-saving tips, at the MedBen Employer Benefits Roundtable on Thursday, May 11. Sign up by contacting Sales Analyst Sally Wood at (800) 423-3151, ext. 502 or emailing firstname.lastname@example.org.
The importance of primary care physicians to improved population health goes well beyond "simple office visits," says Asaf Bitton, an internist and assistant professor at Harvard Medical School and Brigham and Women's Hospital, to The Daily Briefing:
"Primary care, when done well, is a method of care that basically offers valuable core functions for people and health systems. It offers first-contact access, it offers coordination, it offers continuity, it offers comprehensiveness, and it offers a whole-person approach. These functions are complex and deeply valuable to people.
"If you want a system that produces population health, that addresses those key functions, including providing a safe, patient-centered system, you have to have a robust primary care foundation."
Dr. Britton's comments lie at the heart of what MedBen espouses through its WellLiving program: The relationship between the patient and the family doctor sets the foundation for population health management... and by building this relationship through regular wellness exams and screenings, the doctor is better able to advise the patient regarding the proper path they should take to achieve optimal health.
In short, the WellLiving "physician first" approach translates to a healthier workplace... and, as our experience has shown, long-term employer savings. Learn more about the physical and financial advantages of population health management through WellLiving by contacting MedBen Vice President of Sales & Marketing Brian Fargus at email@example.com.
MedBen University (MBU) is pleased to announce an additional event for the 2017 season: The Employer Benefits Roundtable, which will be held at the C. Arthur Morrow Conference Center, 1821 W. Main Street, Newark, Ohio (located next to the MedBen home office) on Thursday, May 11, from 8:30 a.m. to 1:00 p.m. EST.
At this free roundtable, our team of benefits management professionals will speak on a variety of helpful topics for self-funded employers, including:
Unlike our recent industry-specific roundtables, this event is open to all employers, be they MedBen clients or non-clients.
If you haven't had an opportunity to attend an MBU session this year, we invite you to join us at the Employer Benefits Roundtable! To RSVP, simply contact MedBen Sales Analyst Sally Wood at (800) 423-3151, ext. 502 or emailing firstname.lastname@example.org.
The Affordable Care Act (ACA) requires that issuers and health plans provide a Summary of Benefits and Coverage (SBC), including a description of what the health plan covers and the cost sharing responsibility of the consumer, in order to help individuals make more informed choices among health plan options and to better understand their coverage. Self-funded health plans and health insurance companies are also required to provide a comprehensive uniform glossary of commonly used health coverage and medical terms.
The federal agencies overseeing the ACA have recently finalized changes to the existing SBC template in order to improve the readability for consumers, and also to expand the amount of information that the consumer receives from this one document. The new templates include more information about cost sharing, such as enhanced language to explain deductibles and a requirement that plans address individual and overall out-of-pocket limits.
All SBC’s include coverage examples that demonstrate the cost sharing amounts an individual might be responsible for in three common medical situations. Currently, the SBC contains two coverage examples, which address diabetes care and childbirth. The new template offers a third coverage example which addresses coverage for a foot fracture so that a consumer understands the services and expenses that a plan will cover in an emergency scenario.
Use of the new template will be required for plans and insurance policies with plan years beginning on or after April 1, 2017. This also means that the new template should be used for SBC’s that will be distributed for any open enrollment period preceding the April 1, 2017 plan year.
There are no changes to the existing SBC distribution requirements. SBC’s are required to be distributed, as follows:
If you are a MedBen client, please make sure to provide us with enough time to update your SBC and send it to you for timely distribution. It is important that you inform us in advance if you will be making changes to your plan documents which require changes to your SBC.
Should you have any questions about SBCs, please contact Sierra See, J.D., in MedBen’s Compliance Department at email@example.com.
On March 21, the Centers for Medicare and Medicaid Services delayed the expansion of the Comprehensive Care for Joint Replacement (CJR) as well as the implementation of cardiac bundled payment initiatives. This marks the second such postponement of these mandatory programs in as many months.
According to a statement by the Department of Health & Human Services (HHS), the reason for the delay is "to allow time for additional review" and modifications if necessary, and to ensure participants understand the rules.
At MedBen Analytics, we believe that a program works best when all participants are fully engaged in its success. And while we work with hospitals who participate in voluntary programs like the Medicare Bundled Payments Care Initiative (BPCI) as well as in mandatory models like CJR - and have in both instances received positive feedback about our reporting portal and the resultant savings - we think that the decision to implement a value-based payment program is best left to providers, not to the government.
MedBen Analytics was created to give providers the insights they need to improve performance - and our goal is win clients by proving that the bundled payment model saves clients time and money over traditional fee-for-service. If you ever have questions about how our services can benefit your business, please call MedBen President & COO Kurt Harden at 888-633-2364 or email firstname.lastname@example.org.
Sleep is essential to a healthy lifestyle. Adults who do not receive the National Sleep Foundation’s (NSF) recommended seven to nine hours of sleep make themselves susceptible to many negative health impacts. These include increased risk of heart disease and type II diabetes, weight gain, depressed mood and even fatigue.
If you’re struggling to fall asleep at night, try changing your before-bed diet. Items that release tryptophan into your body (like turkey, causing the infamous Thanksgiving nap) help to aid your sleep, and eating foods with carbohydrates allows the tryptophan to become more accessible to the brain. Also, contrary to common belief, alcohol is a poor sleeping aid. While it does make you drowsy, it can also interrupt the sleep pattern throughout the night.
But just as what you eat before bed affects your sleep, your sleep patterns affect your eating habits. Studies have shown that those who are sleep deprived are not only more likely to more fat-rich foods, but also consume more simple carbohydrates and fewer vegetables. This is possibly because sleep loss alters chemical signals connected to metabolism and hunger. In fact, some researchers believe sleep deprivation to be a factor in the rising rates of obesity.
Nonetheless, sleep deprivation should not be left untreated. If you are struggling in the area of sleep, MedBen WellLiving suggests seeing your family physician as soon as possible.
The 15th Annual MedBen Hospital Roundtable, held at the C. Arthur Morrow Conference Center in Newark, Ohio on March 23, gave attendees the chance to review hospital health plan usage trends and compare their plan costs to those of other hospital groups. Plus, the event provided new insights regarding key elements of self-funded plan administration.
This year, our review of performance measures in MedBen's hospital block included a new feature: Expanded regional hospital benchmarking, including both metropolitan and non-metro facilities, that offered a fresh perspective into claim cost, plan design and contribution strategies.
Brian Fargus, MedBen Vice President of Sales & Marketing, took a closer look at the various types of plans commonly offered by metro hospitals, noting the difference in employee contributions to more benefit-rich plans: "Traditional plan premiums run, on average, about 10% higher for participating employees than those with consumer-driven, high-deductible health plans."
Fargus also pointed out that while both community and metro facilities had comparable benefits for domestic (own facility) care, community hospitals had higher average deductibles and employee coinsurance for non-domestic care than their metro counterparts. "And that's good, because better domestic benefits steer more members toward in-house care, which results in lower costs," he observed.
This year's roundtable also examined the importance of a focused approach on population health management. "Uncovering gaps in care and filling those gaps is essential to improving outcomes and optimizing efficiency," said Brooke Hupp, MedBen Regional Sales Manager.
Hupp noted that promoting preventive care, rather than having to take reactionary measures, makes a significant difference in an employer's health care spending. "Detecting a cancer at the earliest stage possible not only improves the patient's chances of survival, but also decreases potential plan costs" she said.
MedBen will conduct its 11th Annual Municipality Roundtable on March 30. Those interested in attending this free event are encouraged to contact MedBen Sales Analyst Sally Wood at (800) 423-3151, ext. 502 or emailing email@example.com.
On March 24, House Speaker Paul Ryan pulled the American Health Care Act (AHCA) ‒ the vaunted replacement to Obamacare ‒ from the floor, lacking the votes to pass the bill. So what happens next? And what can employers do to let their voices be heard?
At the moment, it's difficult to say whether Ryan and the House GOP will regroup and attempt to come up with a more acceptable plan down the road, or just concede defeat and let the Affordable Care Act (ACA) run through its paces and see what happens. Of course, Republicans and Democrats could somehow work through their differences and come up with a solution that's mutually acceptable... though at this point that sounds more like a fairy tale than a realistic scenario.
What is safe to expect is that for the time being, the ACA will remain the law of the land. Even if Congressional Republicans and President Trump could pass a bill in record time, nothing would change until 2018 at the earliest. So for now, it's business as usual.
As we watch developments unfold in the coming weeks, it's important to keep in mind that while the AHCA focused primarily on changes to individual health coverage, it also addressed employer-sponsored plans, albeit to a lesser degree. As noted in a recent article, we were surprised that the AHCA did not eliminate or cap the tax deductibility of group health coverage, instead merely postponing the Cadillac tax until 2026 (or more likely, never). But now that the AHCA is no more, the possibility still exists that a provision to eliminate this benefit could resurface in future legislation.
The employer exclusion tax benefit (Internal Revenue Code (IRC) Section 106) makes employer-sponsored health coverage a valuable benefit for workers and a valuable tool for employers to attract, hire and retain top talent. Eliminating this employer tax exclusion would, in turn, eliminate most of the advantages of employer-sponsored group health coverage, while capping it would degrade the benefit of plan coverage for employees.
Even though the future of "repeal and replace" is cloudy at the moment, MedBen believes in remaining proactive. For that reason, we are urging our Senators and Representatives to maintain the system that has worked for Americans for decades, and to preserve the tax incentives for employer-sponsored group health coverage by leaving IRC Section 106 in place, without modification. And we urge you to do the same.
One thing that we can say with certainty: Whatever the outcome of health care reform, MedBen is here to answer client questions and assist in any way we can. You are welcome to contact Vice President of Compliance Caroline Fraker at 800-851-0907 or firstname.lastname@example.org.
MedBen takes no small measure of pride in its advanced claims surveillance system, and for good reason. In 2016, claims flagged by this system and reviewed by a team of medical specialists experienced an average cost reduction of 25%, after deductibles, coinsurance and PPO discounts. Overall, our clients saved an average of $9.75 per employee per month (PEPM), all thanks to this process.
Furthermore, looking at the PEPM amounts from 2012 to 2016, we found a five-year average client savings of $11.46 PEPM.
It's important to note a few things about our claims surveillance system. First, the savings it generates are in addition to what MedBen produces through plan design, network discounts, medical management, and other cost controls. Second, these savings are produced after network discounts are applied, but before claims are paid.
Finally, the surveillance review is preceded by our own in-house claims processing system. MedBen uses more than 400 auto-checks to detect billing errors and properly apply network discounts. In short, when it comes to your claims, we leave no stone unturned to ensure that clients pay only what is fair and necessary.
Learn more about claims surveillance and other MedBen saving solutions by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
Poets and singers like to expound upon things we can see in other people's eyes... love, hurt, the world, and so on. To that list we may soon add "poor leg circulation."
According to HealthDay News, researchers at Johns Hopkins University in Baltimore said changes in the eye's retina may help spot people at risk for a narrowing of the large blood vessels in the legs – a condition called peripheral artery disease (PAD). While PAD can be difficult to diagnose, the research suggests that someday it could be spotted through a routine vision examination.
Already, doctors can detect early signs of such chronic conditions as high blood pressure, high cholesterol, and diabetes simply by checking their patients' eyes. When you put that on top of such basic considerations as vision correction, you get a pretty good idea of just how valuable a vision benefits program like MedBen VisionPlus can be.
With VisionPlus, businesses can offer vision coverage that promotes the importance of annual eye exams and early detection and treatment of visual impairments. Employers have the freedom to determine copayment levels and the frequency of covered exams and materials. You can put together the plan that best meets your employees’ needs, while adding an attractive incentive to prospective employees.
Good vision coverage goes beyond what you can see with your own eyes. Learn more about the MedBen VisionPlus advantage by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Two MedBen University industry-specific roundtables are just days away... so if you've been thinking of attending, now is the time to register!
On Thursday, March 23, MedBen will host the 15th Annual Hospital Roundtable, sponsored by ISU Stop-Loss. Then on Thursday, March 30, we'll focus on government groups at our 11th Annual Municipality Roundtable, sponsored by HCC Stop-Loss. Both events will spotlight cost and utilization trends for medical and pharmacy health plans, and allow attendees to benchmark their health plans against other plans in their respective industries.
In addition, our team of benefits management professionals will discuss current topics of interest to self-funded employers, including what the future may hold for health care reform.
These free roundtables will take place from 8:30 a.m. to 1:00 p.m. EST at the Morrow Conference Center, 1821 W. Main Street, Newark, Ohio (next door to the MedBen home office). Registration begins at 8:00 a.m., and continental breakfast and lunch will be provided.
Register today by calling MedBen Sales Analyst Sally Wood at (800) 423-3151, ext. 502 or emailing email@example.com. We look forward to seeing you!
A few reminders for MedBen clients who offer flexible spending accounts (FSAs) and/or health reimbursement arrangements (HRAs) to their plan members:
For most FSA and HRA plans that have a January effective date, March 31, 2017 is the final day of the run-out period in which plan members can turn in reimbursement requests for qualified 2016 purchases. Alternately, your FSA plan may allow a "grace period" for members to spend remaining 2016 funds by March 15, but still adhere to the March 31 deadline for reimbursement requests.
Some FSA and HRA plans may have a different run-out period. If you need clarification about your plan's deadline, just call MedBen Customer Service at 800-297-1829.
MedBen clients with additional questions regarding their FSAs or HRAs may call MedBen Customer Service at 800-297-1829.
One of the major surprises of the Republican replacement plan to the Affordable Care Act ‒ tentatively called the "American Health Care Act (AHCA)" ‒ is not what's in it, but what House members left out: A provision eliminating or capping the tax deductibility of employer-sponsored group health coverage.
The provision was noteworthy in its absence because several GOP replacement bills had offered taxing employer-sponsored plans as a possible funding mechanism ‒ and indeed, an earlier leaked draft of the AHCA included such a provision. Why the provision was ultimately omitted is anyone's guess, but it's probable that many House Republicans feared a backlash from employers, many of whom would simply discontinue offering health coverage rather than paying prohibitively expensive taxes on it.
So what does the AHCA propose as a possible way to finance the law? None other than the oft-maligned "Cadillac" tax, once all but dead and buried, now miraculously resurrected. But rather than deal with the inevitable blowback by rolling out the tax immediately (or in 2020, when it's currently scheduled for implementation), the bill pushes the start date all the way back to 2025. The greater likelihood, however, is that the tax will never see the light of day ‒ its real purpose may be to have some funding mechanism in place when the Congressional Budget Office (CBO) scores the bill for potential costs.
Of course, the final version of the AHCA could be very different than the present one ‒ in fact, the brickbats currently being thrown by fellow GOP members at the bill all but ensures that significant revisions are forthcoming. So while employer tax breaks are unaffected at the moment, don't be shocked if talk of elimination or caps arises again.
Finally, while health plan taxes are particularly germane to MedBen clients, they're hardly the only aspect of the AHCA that may affect employers. As the bill evolves, we'll continue to keep you informed on the latest developments and what they mean for your business. In the meantime, clients with questions about the AHCA are welcome to contact Vice President of Compliance Caroline Fraker at 800-851-0907 or firstname.lastname@example.org.
CMS recently announced that, beginning this month, they will switch from quarterly data feeds to monthly data feeds for Comprehensive Care for Joint Replacement (CJR). For MedBen Analytics clients, this means the 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 email@example.com.
Earlier this month, House Republican leaders released an outline of their plan to replace the Affordable Care Act (ACA). The outline doesn't indicate how the plan would be paid for, but one frequently cited GOP funding suggestion ‒ capping the tax deductibility of employer-sponsored group health coverage ‒ could have serious ramifications for employer-funded health plans, says MedBen Vice President of Compliance Caroline Fraker.
Employers provide non-taxable health care coverage through insurance and self-funded plans to the nearly 60% of non-retired Americans who receive coverage through their workplace. Because the benefits provided by employer-sponsored group health coverage is not considered income to employees – and neither employees nor employers pay payroll tax on those benefits – some Republicans see it as an unfair advantage over those who have to purchase health coverage on an individual basis, which is bought with after-tax dollars. "GOP members of Congress think a cap has to be put in place to balance the playing field for those getting health coverage outside of the employment arena," Fraker said.
The logic behind the cap is similar to the ACA's much-reviled (and never implemented) Cadillac tax ‒ to collect funds for other health care reform initiatives. Fraker believes a better solution would be to focus on making corrections to the individual insurance market, such as applying universal health care tax credits to people who purchase their own coverage. "If the GOP believes there's inequity, it's smarter to balance it on the non-employer, individual market side," she said.
Fraker added that that the cap goes beyond simple tax implications to the issue of job retention: "If you take away the tools employers use to attract and retain good employees, all you ultimately do is undermine the economy."
MedBen clients who have questions about the proposed cap or health care reform in general are welcome to contact Fraker at 800-851-0907 or firstname.lastname@example.org.