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Both Centers for Medicare & Medicaid Services (CMS) and private payers are rapidly accelerating 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.
Actuaries are central to helping both providers and payers determine how to align incentives so that quality care can be provided to patients at lower costs. Through the lens of various standardized CMS programs, we will explore the tradeoffs inherent in various risk sharing, benchmarking, attribution, incentive, population health, quality measurement and other techniques central to the provider risk sharing space.
During the boot camp, there will 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
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 fit as a whole.
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. In addition, the boot camp will introduce how actuaries can navigate and help address these issues.
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.