The following videos are from Matt Emery, FSA, MAAA, CERA. Matt is a Vice President of Actuarial at HarmonyCares. He is an avid SOA volunteer. Matt brings a background and expertise in Value Based Care, Medicare Advantage, and Pharmacy pricing.
In this video Matt Emery delves into the transformative landscape of Value Based Programs within Medicare. With a keen eye on aligning regulators, insurers, and healthcare providers, emery highlights the stark differences between the traditional Fee-For-Service model (FFS) and the evolving paradigm of Value Based Care (VBC) He emphasizes VBC’s focus on incentivizing improved patient outcomes, cost-efficiency, and equity, underlining the critical role of CMS and its strategic goals for widespread adoption. Matt navigates through key programs like MSSP and REACh, showcasing their eligibility criteria, assignment methodologies, and approaches to calculating savings or losses, while shedding light on the nuanced tracks within these models that balance risk and reward for participating ACOs. Contributors: Matt Emery, FSA, MAAA, CERA; Mitchell Momanyi FSA, MAAA; Jon Forster ASA, MAAA.