- Why accurate claims coding for MSSP ACOs has become increasingly important
By Jonah Broulette, Noah Champagne, Kathryn V. Fitch | 26 June 2018
This brief explains how benchmark year 3 risk scores affect the benchmark calculation for Medicare Shared Savings Program (MSSP) renewals, presents an overview of the prior and new MSSP benchmark calculations, and illustrates how the change can affect an accountable care organization’s benchmark under various scenarios.
- Considerations regarding the Next Generation ACO stop-loss methodology
By Hugh Larson, Timothy J. Wilder, Annie Man, Coleen Young | 22 December 2017
This report identifies several important considerations regarding the impact of the stop-loss provision on participating Next Generation accountable care organizations.
- Individual stop-loss is now optional for Next Generation ACOs
By Hugh Larson, Timothy J. Wilder, Annie Man, Coleen Young | 08 November 2017
For some Next Generation Accountable Care Organizations, the choice between an annual financial reconciliation based upon capped claims or uncapped claims could have a significant impact.
- Next Generation ACO Program financial results for 2016
By Hugh Larson, Timothy J. Wilder, Annie Man, Coleen Young | 08 November 2017
This paper describes the financial results of the Next Generation Accountable Care Organizations program.
- What predictive analytics can tell us about key drivers of MSSP results
By Jill S. Herbold, Anders Larson, Cory Gusland | 28 September 2017
This article provides insight into the 2015 gross savings/(losses) achieved by accountable care organizations in their third performance year of the Medicare Shared Savings Program.
- Telehealth under alternative payment models
By Susan Philip | 13 September 2017
Telehealth has the potential to boost the impact of population health management initiatives while improving access and convenience of healthcare delivery.
- Regulatory capital strategies in an evolving health insurance landscape
By David M. Liner | 30 August 2017
As the relationship between health plans and healthcare providers continues to evolve, this landscape creates new financial opportunities for health plans managing regulatory capital.
- Performance of skilled nursing facilities for the Medicare population
By Anders Larson, Jill S. Herbold | 09 December 2016
This report discusses a framework and metrics for measuring skilled nursing facility (SNF) performance, explores SNF performance levels across the United States, and provides a quantitative assessment of the opportunity to reduce spending for SNF services through steerage of patients to more cost-efficient SNFs.
- Five common pitfalls in commercial ACO shared risk arrangements
By Adam Laurin, Cory Gusland | 31 August 2016
For shared risk agreements to be transformational, providers and payers must work together to construct agreements that adequately reward providers, are economically viable over a multiyear period, and strive to transfer care management risk.
- Next Generation ACO Model: Should we take the plunge?
By Charlie Mills, Cory Gusland, Noah Champagne | 31 March 2016
This article identifies five key considerations that all accountable care organizations (ACOs) should closely review before deciding whether or not to use the Next Generation ACO Model.