Value-based care models rely on financial incentives to change both provider and subscriber behavior. The field of behavioral economics can enhance traditional actuarial methods to predict actual participation rates and performance, as well as success in value-based financial models. This session examines behavioral economics principles through operating public and private value-based care arrangements, including Centers for Medicare and Medicaid Innovation (CMMI) models as well as private models focused on the Medicare population. The session will highlight how behavioral biases shape value-based care results. For example, how loss aversion drives asymmetric responses to upside versus downside risk, how status quo bias may explain lower-than-expected accountable care organization (ACO) formation, and how present bias affects preventive care utilization. Speakers will show how incorporating behavioral factors improves participation forecasting, risk-sharing arrangement pricing, and quality bonus structure design. Attendees will come away with an understanding of behavioral economics principles affecting value-based payment models. They will also be able to recognize systematic prediction errors in traditional actuarial approaches and identify opportunities for applying behavioral economics tools to improve actuarial practices such as pricing and provider network modeling.
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Presenter(s)/Moderator(s)
Robert D. Lieberthal, Ph.D.
Presenter(s)
Andrew Philip
Group Director, CMMI
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