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 email@example.com.
Recently, we discussed here how MedBen helps to keep self-funded, non-grandfathered plans compliant with new preventive care requirements under the Affordable Care Act (ACA). However, it's not enough to just monitor new recommendations — we also continue to watch for any clarifications on existing recommendations.
As you may know, under the ACA, non-grandfathered health plans are required to cover preventive care recommendations at 100% when services are obtained through an in-network provider. The recommendations come from the U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices, and guidelines supported by the Health Resources and Services Administration that are applicable to women and children.
From time to time, the Departments of Labor, Health and Human Services and the Treasury (the “Tri-Agencies”) will release joint FAQs that address commonly asked questions relating to federal acts, including the ACA. It is the goal of the Tri-Agencies to shed light on existing issues and regulations by offering clarifications on recommendations already in effect. Because these are clarifications and not new recommendations, the Tri-Agencies expect these changes to be made to health plans right away, unlike new recommendations which have a future implementation date.
For example, colonoscopies must be covered at 100% in-network under the ACA and have been for some time. A recent FAQ, released in April of 2016, specifies that any medically appropriate bowel preparatory medications that precede the colonoscopy must also be covered at 100%, when prescribed by a health care provider.
MedBen’s Compliance and Group Service Departments work together to make sure your self-funded plan complies with these requirements. Additionally, we will help you to understand the requirements and notify any necessary vendors, such as your pharmacy benefit manager, if applicable.
FAQs can be reviewed on the Department of Labor website.
A complete list of recommendations can be found at the following websites:
MedBen clients who have any questions about the requirements under the ACA are welcome to contact Compliance Supervisor Erin Kelly at firstname.lastname@example.org.
A recent Benefits Pro article explores how the use of predictive analytics can help to reduce wasteful health spending. At MedBen, this statistical approach serves as the foundation of our reporting platform — an approach that helps our clients to know in advance where potential risks are and act accordingly.
As the article notes, the use of data and algorithms by the health care industry to predict particular events benefits plan sponsors in a variety of ways, such as minimizing wrong diagnoses and steering patients toward the most affordable care. For MedBen clients, predictive analytics serves an equally valuable purpose, enabling them to determine and mitigate clinical as well as financial risk.
MedBen reporting offers patient-level drill-down functionality, so clients can identify and target high-risk plan members in need of clinical interventions. When risks are found, we work with the client to chart an effective course of action. This can range from making strategic plan benefit changes to simply encouraging members to get their cholesterol checked.
Moreover, the MedBen reporting platform tracks group medical and pharmacy spending trends using existing claims data, and analyzes them against appropriate benchmarks. If changes are deemed necessary, our tools compare various plan alternatives and visualizes the financial impact of those changes on future costs and coverage.
With predictive analytics, MedBen helps clients identify risks and develop solutions to reduce health risk and spending, while maximizing the overall value of their health plans. Learn more about how our intelligent reporting features can save your health plan money by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
Drinking soda has no nutritional benefits for our bodies, but we already knew that. It isn’t the healthiest choice, nor does it provide much hydration. The taste is generally why Americans consume more than 44 gallons per person per year. So what really happens when you drink a 12 oz. can of, let’s say, Coke?
About 20 minutes in, your body receives 100% of its daily intake of sugar (that’s ten teaspoons!). The only reason you don’t instantly vomit from the sugar overload is because the phosphoric acid cuts the flavor. With so much sugar at one time, your blood sugar spikes, creating an insulin burst, and your liver starts turning all sugar into fat. Within 40 minutes, the caffeine absorption is complete. Your pupils dilate, your blood pressure increases, and your liver is now dumping all of the sugar it can grab into your bloodstream.
The final 20 minutes, dopamine is released in the brain, and a compound in your lower intestine is created to further boost metabolism. But before that compound can make its way to your bones (along with the sodium, electrolytes, and the minimal water consumed), it will be excreted via the urinary track. You are now only left with the irritable and drowsy feeling known as a sugar crash.
Not only are the short-term effects of drinking a can of soda less than appealing, so are the long-term effects. Some studies have shown there is a connection between drinking soda and conditions such as stroke, weight gain (linked to type II diabetes), kidney stones, liver damage, and much more.
Is that taste still worth it?
Happy Independence Day from MedBen!
In observance of the holiday, our home office will be closed on Monday, July 4 and reopen at 8:00 a.m. on Tuesday, July 5. Hopefully your day off is all about cookouts with friends & family and community fireworks... but should you need claims or benefits information, our online customer service center, MedBen Access, is open for business!
MedBen Access offers a number of useful management functions, such as ordering ID cards, monitoring claims activity and reviewing change of information requests. Plan members can check a claim's status, review Plan Document coverage and download forms, to name just a few of the 24/7 services available.
The entire MedBen team wishes you a safe and relaxing 4th!
The use of bundled payments in commercial settings can reduce costs and help self-funded plans rely less on networks, MedBen Vice President of Compliance Caroline Fraker commented during the "Administering Physician Claims with Bundled Payments" webinar on June 23. The webinar was sponsored by the Society of Professional Benefit Administrators (SPBA), of which Fraker serves as a board member.
"Plan sponsors are looking for lower cost and consistency while providers are looking for administrative ease and market share," Fraker said. "Bundled payment models will stimulate quality improvement and push forward alternative payment methods."
Currently used primarily to reimburse Medicare claims, bundled payments serve as a pricing "middle ground" between fee-for-service and capitation. The Centers for Medicare and Medicaid Services has set a goal that 50% of payments will originate from alternative payment models by 2018, and it's expected that private health plans will follow in turn.
Fraker noted that the transition in the commercial sector has already started. "Large employers in your communities are already experimenting with some form of bundled payment models. And because hospitals want to rid themselves of PPO network contracts, they'll likely move all services in that direction once they become comfortable with Medicare bundled payments," she said.
MedBen already has a head start on working with the bundled payment concept. Through our MedBen Analytics service, we're helping hospitals take raw Medicare claims data and convert it into actionable insights that improve quality of care, while controlling costs.
Our growing experience in this area, combined with our proven benefits administration expertise, will soon allow commercial employers to benefit from alternative payment models as well. MedBen is in the process of rolling out commercial bundled payment services to clients.
Despite the hope that an influx of new insureds through the Affordable Care would reduce the rate of emergency room (ER) visits, new data indicates that patients still seek care there at disproportionately high numbers. It highlights the need to offer benefits that promote ER visits for real emergencies, while encouraging those with less urgent needs to contact their family doctor first.
According to the Centers for Disease Control, in 2012 the ER visit rate in the United States was 42 visits per 100 persons, and about 20% of children and adults visited the ER at least once during the year. Private insurance was the most common form of payment, at 29%.
ER benefits can be tricky, as no health plan wants to discourage individuals from visiting an ER when the need is vital. But the relative convenience of the ER results in a large number of patients who could be better served by a primary care physician, ultimately costing the client much more for the same care. MedBen help clients to find the right benefits balance.
As with all aspects of plan design, MedBen works with clients to help them offer ER benefits that properly address employee population needs. Demographics, geography and claim history all factor into the plan design process, and MedBen is experienced in considering all of these elements.
Because every benefit affects care usage and costs, MedBen takes your plan design seriously. Learn more about how we do it by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
As medical costs continue to escalate, health plans are increasingly exploring payment options that go beyond the traditional fee-for-service structure — and the same may soon apply to prescription drugs.
According to Stat, a recent survey reveals that most health plans would like to pay for many of the highest-priced medicines based on patient outcomes. Either the health plan would receive an extra discount from a drug maker if a medicine does not help patients as much as expected, or conversely, a drug maker may get a credit toward a rebate provided to a health plan if a drug outperforms rival medicines.
The survey of 42 U.S. health plans representing 161 million insured people found that 63% of respondents had a strong interest in outcomes-based contracts for costly hepatitis C treatments. Other expensive specialty drugs in which respondents expressed "high" or "very high" interest in such contracts include oncology medications (53%), rheumatoid arthritis drugs (41%), and multiple sclerosis treatments (35%).
The interest in outcomes-based contracts is “dramatically accelerating right now because the data is available, and it’s getting much easier to track drug performance,” said Dan Mendelson, the head of Avalere Health, which conducted the survey. Growing competition in some therapeutic categories has also fueled the demand.
Some six years after the introduction of federal health care reform, House Republicans have formally unveiled a replacement for a repealed Affordable Care Act, The New York Times reports. Speaker Paul Ryan (R-Wis.) said the plan would slow the growth of health spending and relax federal rules for health insurance, but did not provide a cost estimate or funding mechanism.
Of specific interest to employers, the proposed plan would place a cap on tax-free contributions to employee health coverage, as an alternative to the unpopular "Cadillac tax." House Republicans claim the cap would affect “only the most generous plans.” However, James P. Gelfand, senior vice president of the ERISA Industry Committee, counters that the tax would "threaten the employer-sponsored health insurance that so many Americans enjoy.”
The 37-page white paper does retain several of the ACA's more popular provisions, such as allowing young adults to keep coverage under their parents' health plan to age 26 and forbidding health insurers to charge individuals higher premiums for pre-existing conditions. But it would effectively eliminate federal insurance marketplaces and loosen rules that require Americans to carry health coverage.
Additionally, the plan would:
The U.S. Preventive Services Task Force recently reiterated its recommendation that adults age 50 and over receive regular colon cancer screenings until at least age 75, but did not specify a preferred screening method. MedBen WellLiving promotes similar guidelines while supporting colonoscopies as the best testing option.
In a USPSTF news release, former Task Force member Dr. Douglas Owens said, "There are multiple screening options for colorectal cancer that reduce the risk of dying from the disease. We encourage people to choose the best option for them, in consultation with their clinician."
However, HealthDay News notes that many doctors consider colonoscopy to be the "gold standard" test.
"There is only one test — colonoscopy — that can both diagnose a polyp/cancer and remove or sample it at the same time," said Dr. Arun Swaminath of Lenox Hill Hospital in New York City. "This is key, because a positive stool test plus stool DNA test (such as Cologuard), or a positive imaging test (such as CT colonoscopy) will still require a follow up colonoscopy to confirm and treat the problem."
The MedBen WellLiving program follows the American Cancer Society recommendation that adults get a colonoscopy screening once every 10 years, beginning at age 50. WellLiving members can check their compliance with colonoscopies and other critical wellness examinations by visiting the MedBen Access website and clicking on the "MedBen WellLiving" link under “My Plan”.
To learn more about the advantages of promoting preventive screenings through MedBen WellLiving, contact Vice President of Sales and Marketing Brian Fargus at email@example.com.
As part of an "employer verification study," the Department of Health and Human Services (HHS) is currently contacting employers to determine whether they are offering an "affordable/minimum value" plan to their employees. The Self-Insurance Institute of America reports that the HHS, through a third-party contractor, is conducting the study in order to get a better idea of how many employers offer minimum value plans under the Affordable Care Act.
The reason behind the survey concerns premium subsidies available through ACA Exchanges. If an individual wishes to enroll in a health plan sold through an Exchange and receive a subsidy to cover a portion of the cost, the Exchange must first determine whether that person was offered a minimum value plan by an employer. Those who could get a minimum value plan through their job are ineligible for the subsidy.
The task of determining subsidy eligibility was supposed to be simplified through the use of an "electronic data source" proposed by the ACA. However, to date no such source is available, meaning that the Exchange will have to call an employer directly — hence the agency's interest in ascertaining the percentage of employers that don't offer minimum value plans.
If you do get a call from HHS's third-party contractor, understand that you are under no obligation to answer any questions — but if you do, the survey should take no longer than 15 minutes to complete. The study began in April and is scheduled to conclude at the end of June.
If you're a MedBen client and not sure whether your plan provides minimum value to your employees, you are welcome to contact Vice President of Compliance Caroline Fraker at 800-851-0907 or firstname.lastname@example.org.
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 email@example.com.
Sometimes, it's the simple things that can make a big difference. Case in point: A new study suggests that offices equipped with alcohol-based hand sanitizers can reduce provider claims related to cold, flu, and other preventive illnesses by nearly one-quarter.
According to Drug Store News, the study found that, in comparing an office environment in which hand sanitizers were placed strategically throughout the workplace (including desks) to one which limited their availability to bathroom dispensers, there was:
Now, it must be noted that the study was clearly intended to promote the effectiveness of hand sanitizer products, so the results have to be judged in that context. Moreover, hand sanitizers shouldn't serve as a substitute for soap and water if they're available.
The Centers for Disease Control says that sanitizers with an alcohol concentration between 60–95% are more effective at killing germs than those with a lower alcohol concentration or non-alcohol-based hand sanitizers, which may just reduce the growth of germs rather than kill them outright.
Heart disease is too often thought of as a condition that affects men more than women. But women are equally at risk, and as such, are equally well-served by developing a professional relationship with a primary care physician.
The connection between breast cancer and women's health rightfully gets a great deal of media and public attention. However, you may be surprised to learn that, when mortality rates are compared, roughly 10 times more women die each year from heart disease. In fact, the condition claims the life of 1 in every 4 women.
Nor is the condition limited to the elderly. Young and middle-aged women also are at risk for heart disease ‒ in particular, those who smoke, are obese, or have a family history of heart disease. Moreover, symptoms tend to be less pronounced than in men, making it harder to diagnose.
MedBen WellLiving emphasizes the importance of annual wellness exams. But equally important is the accumulated knowledge that comes from yearly visits to your family doctor... knowledge that improves the odds of detecting the warning signs of heart disease before they become life-threatening.
Primary prevention through the MedBen WellLiving program helps employers save money, but it's greatest benefit is its potential to improve lives, and in some cases, save them. Learn more by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
The health care industry has become merger-happy in recent months, but many employers want no part of it. Neither, for that matter, does MedBen.
According to Modern Healthcare, "several surveys of Fortune 500 companies and other big employers reveal nervousness that the reduced competition among health insurers will mean higher health care costs for them." In one such survey, 95% of respondents viewed the loss of competition as a negative.
In an industry where mergers and buyouts make headlines seemingly every week, MedBen is something of an anomaly — growing and thriving as a benefits management company while remaining independent for nearly 80 years. And we believe it's that very autonomy that has allowed us to thrive, by allowing us to make changes quicker, to try new ideas sooner, and to respond to customer requests faster.
Moreover, because MedBen is a private company and not beholden to a parent or partner, we have the freedom to negotiate provider network discounts with the sole purpose of saving clients money. "We make decisions based on what is best for the customer, not what is best for the stockholders," said MedBen Chairman & CEO Doug Freeman.
Finally, MedBen has prospered in a climate where the Affordable Care Act is essentially rewriting the benefits management playbook on a regular basis. But rather than look for answers from other companies, we've embraced the challenge and responded with new product offerings and additional ways to save clients even more money.
"We have good people, some of whom have been with us for decades," Freeman said. "And they bring a combination of experience and great instincts that enable MedBen to stay proactive at a time when other companies are taking a 'wait-and-see' attitude, or looking for help elsewhere."
In short, to paraphrase a popular 1980's ad campaign, MedBen doesn't buy your business... we earn it. (Bonus memory points if you heard that in your head with John Houseman's voice.)
So, you love your job, but it requires you to sit for 7-8 hours per day. What can you do? It’s not unordinary, especially in a workplace, to sit for long periods of time. As we do, we find our bodies losing muscle mass, and gaining the opposite… fatty tissues. “Deskercise” – or exercise at your desk – can help!
As funny as the term may seem, deskercising is fairly simple and the results can help to reduce your health risks while improving your mood. MedBen WellLiving promotes, for overall health, a person get regular exercise of at least 30 minutes, 3 days a week. Though deskercising will not account for all aspects of “regular exercise” it’s a good place to start.
And start soon! The University of Chicago revealed that those who live sedentary work lives averaged a Body Mass Index (BMI) of 3.3 greater than those who were active and are twice as likely to be overweight. Even more shocking than physical appearance, WebMD states that studies have also linked excess sitting to worse mental health, higher risk of heart disease and heart attack, and even a higher risk of being disabled. YIKES!
Getting started is simple and discrete. Below you’ll find some examples of how you (and anyone at your office) can start deskercising today.
If you've been paying attention to the news lately, you've likely heard and read stories about the Zika virus disease. While the virus has been known of since 1947, it had until recently remained largely confined to outbreaks in tropical Africa, Southeast Asia, and the Pacific Islands. But in the last year, incidences of local transmission have been reported in many other countries, including the U.S.
The Zika virus disease is rarely fatal, and if contracted is unlikely to reoccur. However, Zika virus infection during pregnancy can cause a serious birth defect called microcephaly (which is characterized as a smaller-than-normal head for a baby), as well as other severe fetal brain defects.
The most common symptoms of Zika are fever, rash, joint pain, or red eyes. Other common symptoms include muscle pain and headache. Symptoms can last for several days to a week.
Zika virus spreads to people primarily through the bite of an infected Aedes species mosquito, but can also be contracted through intercourse as well as from a pregnant woman to her fetus. If you live in a state or area with the mosquito that spreads the Zika virus and you are concerned about it, you can build your own Zika Prevention Kit. It should include:
The Centers for Disease Control has put together a Zika Basics document which is available for download at their website. The CDC site also features a dedicated Zika section with detailed information about the disease and preventive steps to take.
PHOTO: By Muhammad Mahdi Karim (www.micro2macro.net) Facebook Youtube - Own work, GFDL 1.2, https://commons.wikimedia.org/w/index.php?curid=11185617
The growing number of obese adults in America is sometimes referred to as an "epidemic," even though medical efforts to address the problem tend to be more isolated in nature than cooperative. Now a major physician group is encouraging doctors to work together to find a solution, MedPage Today reports.
In new evidence-based guidelines for treating obesity, The American Association of Clinical Endocrinologists (AACE) states that obesity is a chronic disease and should be treated as such. While the association first recognized obesity as a disease in 2012, the new guidelines provide a comprehensive model to diagnose and treat the condition.
"The thrust of the final recommendations is to recognize that obesity is a complex, adiposity-based chronic disease, where management targets both weight-related complications and adiposity to improve overall health and quality of life," wrote the guideline authors.
The guidelines incorporate waist circumference, body mass index (BMI) and other measures to determine individuals that should be screened for obesity and related conditions. Physicians can then use that data to determine individual treatment plans including options such as lifestyle and behavioral modification, diet changes, pharmacological solutions, and bariatric surgery.
The AACE is a professional community of physicians specializing in endocrinology, diabetes, and metabolism, and is the world’s largest organization representing clinical endocrinologists.
The staff of MedBen want to wish you and your family a happy and safe Memorial Day!
Our home office will be closed on Monday, May 30 in observance of the holiday. We will reopen at 8:00 a.m. Tuesday, May 31.
During this time, please remember that clients can use the 24/7 online services of MedBen Access to check on benefit coverage and the status of any pending claims. Simply go to MedBen.com and select "MedBen Access". For those who use Pharmacy Data Management (PDM) as their pharmacy benefits manager, you can check on prescription claims and find lower cost drug options through MedBen Access by clicking on the "Rx" button located in the "My Claims" section of this website.
If you're a MedBen Flexible Spending Account (FSA) or Health Reimbursement Arrangement (HRA) participant in addition to having other coverage, you also can use MedBen Access to see your FSA/HRA balances, claims submissions and payments. When you log in to MedBen Access, you'll find an "FSA/HRA Online Inquiry" option (visible only to groups offering MedBen FSAs/HRAs) under the "My Plan" section located on the left sidebar. By selecting this option, users are automatically taken to the MedBen FSA/HRA Online System.
Once again, have a good holiday... and thanks for your continued relationship with MedBen!
One risks sounding like a broken record (or a corrupted MP3 file), but it really is important to the long-term financial health of your pharmacy plan to stress the large and ever-widening gap between brand-name and generic drug costs. As drug costs continue to rise, MedBen believes that an emphasis on generic prescriptions is key to keeping plan costs in check. Toward that goal, we encourage clients to promote generic usage whenever possible... and plan members appear to be in agreement.
MedBen prides itself on keeping client drug costs well below national spending trends. A recent report by S&P Global found that while overall national health care cost rose 6.5% in 2015, drug costs alone increased by 15.8%, and brand name drugs jumped 19.2%. By contrast, MedBen pharmacy plans experienced only a 4.1% trend — due in no small part to the smart use of generic medications.
It's also worth pointing out that, while generics typically cost substantially less than than their brand-name equivalents, MedBen strives to lower generic costs even further. Last year, our average discount on retail generic drugs was 76.9%, and 82.3% for mail order generic drugs. Given these numbers, it should come as no surprise that when a generic version of a brand-name drug is available, the average substitution rate by plan members is an impressive 97.7%.
As prescription drug use increases, a savings strategy must focus on ways to control pharmacy costs. To learn about the methods MedBen employs to help clients achieve their Rx spending objectives, contact Vice President of Sales & Marketing Brian Fargus at email@example.com.