Description: ACOs and payers have been engaged in shared savings agreements for several years now in an attempt to reduce the total cost of care. Often neither party has a complete view of the data with providers missing pharmacy data, and payers are often missing historic data on a provider group’s members when they were previously covered by other payers. Inconsistent data and black box predictive models have created friction that has become amplified given the continual increase in ACO membership and the dollars at stake. Learn how payers and providers are working through these challenges to find solutions that work better for both parties.

Description: MACRA not only impact providers, it will impact the entire healthcare market. MACRA published studies and commentary to date have primarily focused on providers, with the majority of the information addressing the impacts to clinicians. However, our investigation indicates MACRA has far reaching impacts to payers as well as providers. MACRA is impacting each geographic market and line of business in a unique way, and health payers will have multiple strategic decisions to consider given the changing market dynamics.

Description: It has been five years since MACRA was passed and it's still not yet a recognized name, unlike some of its predecessors, DRGs and Stars. That being said, this webcast will explore MACRA’s quiet impact on the healthcare industry and how it has evolved over the years. Experts will look at the influence MACRA has had to date on both payers and providers, and where MACRA may be headed over the next few years.

Description: For years, the healthcare industry broadly and Centers for Medicare & Medicaid (CMS) specifically have been looking for ways to manage ever increasing healthcare costs without compromising quality. In an effort to achieve this goal, CMS has been considering options for shifting financial risk to providers as a way to incentivize practitioners to provide efficient, lower-cost care. The Medicare Access and CHIP Reauthorization Act, or (MACRA) is a sweeping reform designed to, change how providers are reimbursed for Medicare FFS beneficiaries and encourage providers to enter into financial risk sharing agreements for the care of their patients. Although the goal is simple, the details of the program and associated alternative payment models are quite complex. Actuaries are poised to help both payers and providers of all types manage this transfer of insurance risk and create approaches to achieve desired outcomes.

Description: Over the past decade, many health system stakeholders have recognized the influence of Social Determinants of Health (SDOH) on health outcomes. Translating that recognition into action, however, is a significant challenge for both providers and payers. Addressing that challenge begins with data. Approaches to gathering and using SDOH data will be presented in two use cases.