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Changes introduced by various Medicare Alternative Payment Models and the Medicare Access and CHIP Reauthorization Act (MACRA) have accelerated an existing market trend of shifting some of what has traditionally been considered "insurance risk" to providers. The Provider Risk Sharing Boot Camp will give attendees deeper insights into methods, current thinking, and alternative solutions that actuaries can use to help providers understand and manage the financial and actuarial risks that they are taking, many for the first time.
MACRA and related CMS initiatives have fundamentally changed and accelerated the pace at which physicians and other practitioners are being required to take financial risk for the care they provide. The presenters will take attendees through an in-depth exploration of how MACRA and associated Alternative Payment Models (APMs) function and interact. This will include several case studies where attendees will be asked to investigate the financial ramifications and/or unintended consequences of certain features of these programs, and how actuarial analyses and support can assist providers in better decision-making and management decisions.
Attendees will gain a detailed understanding of the Merit-Based Incentive Payment System (MIPS) and its components, Qualifying Participant status, features of the most common APMs (in particular the Medicare ACOs and the Oncology Care Model), and how these programs are likely to impact other market segments. While MACRA and associated APMs are specific to Medicare FFS, we will also discuss how these structures and associated analytic techniques can be generalized to provider risk-sharing structures across the whole healthcare market.
During the boot camp, there will also be an in-depth exploration of the issues, tools and techniques actuaries are most likely to face when working in the provider risk sharing space. This will include the following topic areas:
- Key considerations and identification of potential program risks
- Evaluation and measurement for shared savings / loss arrangements
- Network considerations for value based payment
- Attribution techniques and associated issues
- Actuarial considerations for bundled payment arrangements
- Population health & quality considerations for actuaries
- Financial risk considerations associated with provider group size and panel composition
- Techniques for helping providers quantify the risk / reward of alternative payment models
The boot camp will also include a segment in which the presenters explore some of the practical and cultural considerations that often arise when providers accept financial risk, and how actuaries can navigate and help address these issues.
Level of Difficulty
This program will be technically advanced, focused on giving participants a rigorous understanding of the regulatory and operational issues, and the analytic techniques that can be used by actuaries to help providers successfully manage financial risk.
Attendees will be asked to participate in interactive exercises exploring both actuarial issues and techniques associated with each of the items above, and how provider risk sharing features interact as a whole.