Fred Bentley

Fred Bentley advises clients on health delivery and payment innovation, providing analytic and strategic insight on issues related to the delivery of care.

As an expert in fields ranging from payer strategy to hospital–physician alignment and post-acute care, he has worked with providers, including integrated delivery networks, academic medical centers, post-acute providers, and long-term care organizations as well as national and regional health plans. Over the past 5 years, his work has focused on supporting health systems engage in Medicare and Medicaid payment and delivery system transformation initiatives.

Prior to joining Avalere, Fred was a principal in the Accountable Care Solutions practice at The Chartis Group. In this role, he worked with leading hospitals and health systems in developing strategic roadmaps to guide their clinical innovation, population health, and cross-continuum integration initiatives. He also served as a managing director with The Advisory Board Company, managing a team of consultants and analysts who supported provider organizations ranging from physician groups and health systems to post-acute care providers.

Fred holds an MPP and MPH from the University of California, Berkeley, and a BA in political science from Haverford College.

Authored Content

The roll-out of the Patient-Driven Payment Model (PDPM) in October 2019 followed quickly by the COVID-19 pandemic presents challenges to understanding the extent to which increases in payment to skilled nursing facilities (SNFs) are due to the changes in the payment system versus changes in the patient populations served during the COVID-19 pandemic. Given the confounding effects of the pandemic and the new payment system, it is important to collect more data before evaluating the transition to the PDPM.

Tune into another episode of Start Your Day with Avalere. In this segment, Chris Johnson of Landmark Health joins Fred Bentley, Managing Director in Avalere’s Center for Healthcare Transformation, to discuss his organization’s experience as an early participant in CMMI’s Direct Contracting payment model and how value-based models can advance home-based care.

Digital health will continue to be a focus under recently confirmed Secretary Becerra‘s leadership at the Department of Health and Human Services. As the Biden administration looks to enforce compliance across a range of data interoperability and price transparency rules, as well as usher in new Food & Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS) coverage policies for medical technologies and digital health tools, the industry is responding with a range of innovations.

A new analysis from Avalere estimates the impact of reverting back to the Calendar Year (CY) 2017 Medicare Outpatient Prospective Payment System (OPPS) payment policy that reimbursed all separately payable drugs at average sales price (ASP) plus 6%. Key findings suggest beneficiary cost sharing for separately payable drugs at 340B OPPS hospitals would increase by $472.8 million. Also, 82% of all OPPS hospitals—specifically 89% of rural, 80% of urban, and 49% of 340B hospitals—would see net total payment decreases.

Avalere analysis determined that Medicare Fee-for-Service (FFS) patients receiving home-based care services experienced a decrease in Medicare spending over time when compared to a statistically balanced, matched control group who do not appear to have received home care services. The spending differential was also found to be higher among Medicare beneficiaries with functional limitations and multiple chronic conditions.

New Avalere Health analysis of Medicare fee-for-service (FFS) claims data reveals large decreases in skilled nursing facility (SNF) and home health care use following the widespread decline in inpatient hospitalizations amid the response to the COVID-19 pandemic. Avalere’s analysis further suggests that as inpatient procedures resume in some areas, the volume of inpatient hospital discharges to home health is starting to rebound, whereas the volume of discharges to SNF remains below 2019 levels.

Tune into another episode of Start Your Day with Avalere. In this segment, health plan experts delve into the strategic opportunities the federal government’s interoperability requirements present and consider which mandates might be coming down the pike.

Tune into another episode of Start Your Day with Avalere. In this segment, health plan experts delve into the federal government’s interoperability requirements and how plans are navigating these changes.

With the release of the 2021 Medicare Advantage (MA) and Part D Final Rule, the details of the upcoming policy change that allows beneficiaries with end-stage renal disease (ESRD) to enroll in MA are set. Stakeholders need to adapt quickly to be prepared.

Tune into the ninth episode of our podcast series, Get the Facts on COVID-19. In episode 9, Avalere experts from the Health Plans and Providers practice and the Center for Healthcare Transformation discuss the near- and long-term impacts of COVID-19 on value-based contracting and Alternative Payment Models (APMs). The conversation focuses on Medicare programs, such as specialty Accountable Care Organizations (ACOs) and bundled payment models, and newer Center for Medicare and Medicaid Innovation (CMMI) programs.

Tune into the seventh episode of our series that focuses on COVID-19. In episode 7, Avalere experts from the Health Plans and Provider’s practice discuss the short- and long-term implications for post-acute care as a result of COVID-19.

The COVID-19 pandemic will have ongoing, market-wide implications as Medicare Advantage (MA) plans contend both with responding to the virus and the disruption to their normal activities.

Our panel of experts engaged in an in-depth discussion of the rapidly evolving regulatory environment surrounding COVID-19 testing and treatment and the strategic, financial, and operational challenges this disease presents for health insurers.

Avalere experts discussed the latest policy, reimbursement, and program changes affecting post-acute care and why they matter.

The payer landscape continues to evolve for post-acute care (PAC) providers. Fueled by lower annual costs and expanded benefit options relative to the Medicare fee-for- service (FFS) program, Medicare Advantage (MA) is growing rapidly, now encompassing more than one-third of all Medicare beneficiaries. At the same time, nearly half the states have implemented managed care plans to provide Medicaid long-term care benefits.

Avalere’s analysis found that hospice patients diagnosed with cardiovascular and dementia conditions represent the largest proportion of “live discharges” compared to patients with other conditions.

Skilled nursing facilities (SNF) nationwide continue to adapt to the Patient-Driven Payment Model (PDPM), a transformational new approach to SNF Medicare reimbursement that took effect October 1, 2019.

Despite the oft-repeated mantra that provider collaboration and care coordination are the bedrock of a more rational and cost-effective healthcare system, relationships between hospitals and post-acute care providers remain largely fragmented and uncoordinated.

For the last several years, Avalere has worked with the Alliance for Home Health Quality and Innovation (AHHQI) to analyze the ever-changing home health landscape.

Announced in late April, the Center for Medicare & Medicaid Services’ (CMS) Primary Care First initiative marks a critical step forward in the long and complex journey toward a fundamentally transformed healthcare system.

Liz Moore recently sat down with Fred Bentley, managing director, to talk about the Patient-Driven Payment Model (PDPM) and how it may impact skilled nursing facility (SNF) profitability. Check out the interview below.

Providers in the Bundled Payments for Care Improvement Advanced initiative began to assume financial risk on March 1, 2019.

Tune in as Avalere experts interview each other on hot topics in healthcare. In this discussion, Avalere Managing Director of Health Plans and Providers, Fred Bentley is interviewed by Alexa Trost, Associate, on the current state of value-based care across the health care landscape and critical steps post-acute care organizations needs to take to to succeed in this environment.

Check out the second episode of our series on new supplemental benefits offered through Medicare Advantage plans for 2019 where Kenny Kan and Erica Breese discuss the "rule of 8".

In episode 1 of our series Fred Bentley, Sean Creighton, and Kenny Kan discuss the new supplemental benefits offered through Medicare Advantage plans for 2019.

In August 2018, CMS is expected to finalize a proposed new payment methodology for skilled nursing facilities (SNFs) that would shift the focus from resource use to patients’ clinical needs.

As the deadline approaches for providers to make decisions on their participation in BPCI Advanced, Avalere analysis shows that certain conditions may provide greater opportunity for success.

Avalere's founder and president, Dan Mendelson, recently sat down with Senior Housing News editors to discuss opportunities for senior living providers to leverage data to facilitate synergistic partnerships with payers.

New research from Avalere finds Medicare beneficiaries are spending fewer days in skilled nursing facilities (SNFs) since 2009 on a per capita basis.

On February 9, the Senate voted to pass the Bipartisan Budget Act of 2018, which funds the government through March 23, lifts spending caps for 2 years, and suspends the debt ceiling until March 2019.

Last month, the Centers for Medicare & Medicaid Services (CMS) released a Request for Application (RFA) for the Bundled Payment for Care Improvement (BPCI) Advanced initiative.

With applications for the new Bundled Payment for Care Improvement (BPCI) Advanced initiative due on March 12, providers have a short window to act.

The Centers for Medicare & Medicaid Services (CMS) have released a Request for Application (RFA) for the Bundled Payments for Care Improvement (BPCI) Advanced Initiative.

Analysis also finds that 62% of impacted facilities will experience less than a 5% reduction in Medicare Part B revenue due to the drug cuts, but 6% of applicable hospitals will experience cuts greater than 10%.

Learn more how analytics derived from proprietary commercial datasets empower provider executives to successfully partner across the healthcare industry.

Tune in as Avalere's Fred Bentley explores how a leading health system adapts to evolving value-based payment models in an interview with Dr. Robert Nesse, senior director for Payment Reform at Mayo Clinic.

Learn more about how new models of care are impacting providers as Avalere experts discuss care coordination and care transitions.

As the industry continues to see a shift from volume to value, Avalere experts examine the future of Medicare's Quality Payment Program under a new administration.

New analysis from Avalere finds that Medicare Advantage (MA) patients use fewer post-acute care services after being discharged from the hospital compared to traditional Medicare fee-for-service (FFS) patients.

Avalere recently partnered with the National Pharmaceutical Council to examine payers' perspectives regarding the use of patient data and how it can be used to shape care delivery, improve system efficiencies, and achieve better health outcomes.

Watch this short video of Fred Bentley from our Provider Practice, discuss insights on navigating the transition from volume to value-based care in a changing healthcare environment.

Watch Erica Breese, our post-acute care expert, preview how analytics can reduce readmissions and improve outcomes for patients after hospitalizations.

Fred Bentley fills you in on the core components of the EPM final bundled payment rule and the future of bundled payment models.

Today, the Centers for Medicare & Medicaid Services took another step in shifting Medicare to a value-based payment model that rewards hospitals for delivering better care at a lower cost.

Avalere recently partnered with the Alliance for Home Health Quality and Innovation (AHHQI) to explore the topic of the future of home health care.

Avalere recently partnered with the Physicians Advocacy Institute to examine trends in physician employment and practice ownership by hospitals and health systems from 2012 to 2015.

Recently, Avalere partnered with the Alliance for Home Health Quality and Innovation to better understand how home healthcare is currently being used and how it will be used in the future for older Americans and Americans with disabilities.

CMS released another mandatory bundled payment proposed rule which will significantly expand the scope of hospitals bearing risk for episodes of care nationally.

In our final bundled payment podcast, Avalere's Adam Borden discusses how the potential updates may impact device manufacturers.

In the third podcast in our bundled payment series, Avalere's Mary Ann Clark discusses how the potential updates may impact device manufacturers.

In episode 2 of our bundled payment podcast series, Avalere's Sally Rodriguez shares how the potential updates may impact post-acute care providers.

Avalere experts say that the impact for most hospitals will be modest.

For the month of August, Avalere will cover what the new proposed changes to existing bundled payment programs could mean for the healthcare industry. In an exclusive podcast series, experts will discuss what the new bundles include and where to go from here. Kicking off this series is Fred Bentley from our Center for Payment and Delivery Innovation.

Data show gaps in care integration across provider settings following hospital discharges.

Our experts share the lessons that we’ve learned from our extensive experience with the Bundled Payments for Care Improvement Initiative. The Bundled Payments for Care Improvement demonstration is a voluntary program sponsored by CMMI in which hospitals, physician group practices, and post-acute care providers accept clinical and financial risk for patients over specified episode time frames post-hospital discharge.

In order to better coordinate care across the care continuum, CMS is allowing hospitals to establish “CJR Collaborators” or other providers that share risk with the participating hospital. Listen as Fred Bentley and Erica Breese discuss the details.

The Medicare Access and CHIP Reauthorization Act (MACRA) passed last spring is transforming physician payment and standardizing requirements for APMs. ​Listen as Adam Borden and Jared Alves cover Advanced APMs, incentives CMS offers for providers to participate in APM, and the exclusion of specific tracks.

With the launch of the Comprehensive Care for Joint Replacement (CJR) model on April 1, CMS has ushered in a new phase for payment reform. Under this mandatory program, roughly 800 hospitals across the U.S. will assume financial accountability for the cost of all services provided to Medicare patients during 90-day care episodes for hip and knee replacements.

Are bundled payments fundamentally changing the way care is provided? Listen in as Fred Bentley, Avalere Center & Payment Delivery Innovation, explains how bundled payment models are spurring clinical innovation and the creation of cross-continuum partnerships.

Hospitals should focus on care after discharge, which drives more than 39 percent of spending.

In our patient engagement series, hear Alex Goolsby discuss opportunities for provider organizations, health plans, patient advocacy groups, and drug and device manufacturers to engage patients through education and collaboration to improve healthcare.

A new analysis by Avalere examines differences in Medicare spending for episodes of care before and after cardiovascular imaging, colonoscopy, and evaluation and management services. Avalere applied a risk adjustment methodology to account for differences in patient demographics and patient severity across settings. The findings suggest when care is initiated in the typically higher-paying HOPD setting than in physicians' offices and ambulatory surgical centers, the services that follow also result in higher spending relative to when care is initiated in the office setting.

According to a new analysis by Avalere, a prescription requirement for pseudoephedrine-containing products also fuels the growing shortage of primary care physicians, thereby increasing the cost, time, and difficultly of obtaining the treatment for legitimate users.

A new Avalere analysis finds that participation in the Centers for Medicare & Medicaid Services' (CMS) voluntary Bundled Payment for Care Improvement (BPCI) program remains strong even after the introduction of downside risk.

Believing that states are productive incubators of innovation, the Center for Medicare & Medicaid Innovation (CMMI) launched a State Innovation Model (SIM) grant program in 2013 to encourage state-by-state testing of innovative payment and delivery models.

Avalere analyses show that more than 700 ACOs already operate in the U.S.

On Monday, January 26, Secretary Burwell announced a goal to have half of Medicare fee-for-service payment in alternative payment models (APMs) by 2018.

As risk shifts, so too does the responsibility for delivering high-quality outcomes at lower costs. In this podcast, listen in as Sally Rodriguez discusses the impact of this shift and the momentum surrounding delivery models. Sally explores what’s ahead for this changing landscape and the opportunities that await.

Avalere Health and The SCAN Foundation partner to understand the interplay between medical and non-medical issues. Listen to Avalere’s Sally Rodriguez detail September’s white paper release.

Avalere examines states participating in the ACA expansion that may reduce eligibility levels for some current beneficiaries.

With DSH cuts looming, hospitals should enroll patients in coverage programs to minimize the burden of uncompensated care.

Nowhere are there more opportunities for savings than in post-acute care (PAC) settings.

In this new era of payment reform, understanding patient populations and capabilities of providers outside of the hospital will be critical to success.

Avalere research shows that enrollment in a voluntary long-term care insurance program would not be large enough to shift our financing system from Medicaid to private insurance.

Reducing your hospital's MSPB score is an important first step in preparing to manage your patients' post-discharge costs.

Hospitals aligned with top payers in the exchanges in their service areas will be well-positioned to benefit from increased volumes and revenues once exchanges start in January 2014.