Provider payment reforms, through Accountable Care Organizations (ACOs) and other payment models, are being tested in both the commercial insurance and public funding systems, including Medicare and Medicaid.

Many provider organizations, frequently in partnership with payer organizations, have developed, or are seeking to develop, ACO or ACO-like structures for commercial populations. Also, CMS has issued proposed regulations, fact sheets, applications and other guidance on concepts related to ACOs and provider payment reform: Medicare Shared Savings Program, Patient Centered Medical Homes, Physician Group Practice Transition Demonstration, Medicare Pioneer ACOs and a Bundled Payment Initiative.

Much of the national discussion has centered on care management and technology improvements, yet affordability and bending the cost curve have not been as widely discussed. These evolving organizations and systems are typically spearheaded by providers and, as a result, close attention has been paid to clinical and operational aspects that will contribute to their success. As provider organizations are being called upon to manage new payment models and assume greater responsibility, they need new tools and resources. Some of these payment and risk-sharing models are already being used or tested in the public sector. Others are relatively new. The financial components must be fully integrated with the clinical and operational system components to successfully position these organizations for the upcoming challenges in this environment.

The SOA is seeking a researcher (or researchers) to explore critical non-clinical elements of success for an ACO, with particular attention on reducing costs, managing risk and related actuarial issues. Proposals should clearly demonstrate a highly practical approach and focus on quantification of the drivers that bring success to an ACO. Given this objective of practical, quantifiable results, the SOA is particularly interested in proposals that fully leverage existing and potentially new data sources. To the extent feasible, the results should report on actual data and financial results that demonstrate success, as opposed to purely theoretical examples or restatements of existing literature.

Each proposal should include a statement of impact that addresses the following question: What quantitative results and tools will the project provide, and how can they be used by key stakeholders to enable or measure financially successful accountable care models?

The specific research direction has been deliberately left open to allow respondents flexibility in formulating their proposals and ultimate deliverables, within the constraints of results that are quantitative, practical and contribute to the existing publicly-available literature. Some of the general aspects and questions that might be addressed include, but are certainly not limited to, the following:

• Responsibility and risk. How can high-quality providers manage the shifting of risk?
• Population and attribution. What is the impact of various attribution models, and how does this differ by population?
• Data. How can data be gathered, shared and analyzed to create timely, useful information and metrics?
• Performance models and metrics. What internal and external metrics can best demonstrate success?
• Payment models. What will be the actual cash flow structure within various models, and under various scenarios?
• Product design. How can product design and incentives be used to support a particular payment model for an effective and lower-cost delivery system? How can product design increase patient responsibility?
• Scale and applicability. How much of an influence will ACOs have and to what extent will the concept be used? Within an ACO, how many participants/beneficiaries are needed for stability and reliable measurement and making an impact on the way physicians practice?
• Transition. As the market shifts away from a revenue model based on volume to an accountable model based on outcomes and impact, what are critical factors and timing for organizations wanting to make a successful transition?
• Environment. What are the quantitative market attributes and requirements for a successful ACO?
• Lessons learned. What can be learned and demonstrated from past experiences with managed care? How are ACOs similar or different?

Again, respondents are free to address any or all of the above, or other related questions.

The expected audiences for this research will depend on the deliverables specified in accepted proposals, but are expected to include providers, public officials and administrators, payers and actuaries assisting these stakeholders.

For this effort, the SOA has allocated a budget of $100,000 to $150,000, which includes all aspects of the work, including any related costs. The SOA may award multiple contracts within this budget.

Because of the timelines of the ACA, and the urgency for states to plan and implement exchanges, preliminary results are desired by March 31, 2012, with final results issued by July 1, 2012.

To facilitate the evaluation of proposals, the following information should be submitted:

1. A detailed overview of the process to be followed, including the following information:
1. Proposed methodology, metrics and parameters expected to be analyzed
2. Specific project aims or research questions
3. Statement of problem and purpose of your project
4. How the proposed project will fill a gap in knowledge or improve operations
5. How the results of your study will be used by key stakeholders to enable financially successful ACOs;
2. A detailed description of any data to be used, including whether the dataset(s) to be used is (are) considered proprietary or publicly available;
3. A description of expertise in projecting the financial impact of proposed programs, and in retrospective evaluation of actual programs. This should include a description of financial metrics used to evaluate actual programs. We would prefer to see actual experience in this area, as opposed to using this project to develop new approaches.
4. Any available sample reports from other projects to demonstrate expertise. Data should be masked if necessary for proprietary or confidentiality reasons.
5. Resumes of the researchers, including any less-experienced consultants or graduate student(s) expected to participate, indicating how their background, education, and experience bear on their qualifications to undertake the research. If more than one researcher is involved, a single individual should be designated as the lead researcher and primary contact. The person submitting the proposal must be authorized to speak on behalf of all the authors as well as for the firm or institution on whose behalf the proposal is submitted;
6. A description of the expected report. Note that this report will be available publicly, and is aimed at a more sophisticated audience with public policy and/or financial expertise.
7. A project workplan and schedule for completion of the research, identifying key dates or time frames for research completion and report submission. Preliminary results are desired by March 31, 2012, with delivery of the final report to occur by the end of July 1, 2012. Cost estimates should include computer time, salaries, report preparation, research costs, etc. Such estimates can be in the form of hourly rates, but in such cases, time estimates should also be included.
8. Cost estimates should include (and separately itemize) the costs of other researchers. Any guarantees as to total cost should be given and will be considered in the evaluation of the proposal. While cost will be a factor in the evaluation of the proposal, it will not necessarily be the decisive factor. For this effort, the SOA has allocated a budget of $100,000 to $150,000, which includes all aspects of the work, including any data and model access fees. The SOA may award multiple contracts within this budget; and
9. Other related factors that give evidence of a proposer's capabilities to perform in a superior fashion should be detailed.

The Project Oversight Group (POG) for this project has been appointed and is responsible for the selection of the proposal to be funded. Input from other knowledgeable individuals may also be sought, but the POG will make the final decision. The SOA's Research Actuary and the SOA's Health Staff Fellow will provide staff actuarial support.

The SOA desires to foster connections between actuaries and other health-related disciplines. With this in mind, research proposals from non-actuaries and interdisciplinary teams with actuaries are welcome.

Any questions regarding this RFP should be directed by email to either Steven Siegel, SOA Research Actuary (ssiegel@soa.org) or Sara Teppema, SOA Health Fellow (steppema@soa.org).

If you intend to submit a proposal, please email written notification by November 1, 2011 to: Barbara Scott, Society of Actuaries, 475 N. Martingale Road, Suite 600, Schaumburg, IL 60173-2226 or bscott@soa.org, ph: 847.706.3592, f: 847.273.3592.

Please email a copy of the proposal to: Barbara Scott at bscott@soa.org.

Proposals must be received no later than November 15, 2011. It is anticipated that all respondents who have submitted proposals will be informed of the status of their proposal no later than December 10, 2011, and work on the project will begin at that time.

The SOA reserves the right to not award a contract for this research. Reasons for not awarding a contract could include, but are not limited to, a lack of acceptable proposals or a finding that insufficient funds are available. The SOA also reserves the right to redirect the project as is deemed advisable.

The SOA intends to copyright and publish the results of this research. The research will be considered work-for-hire and all rights thereto belong to the SOA. However, appropriate credit will be given to the researcher(s).