Session 116: Success in Risk-bearing Arrangementsprogram = care delivery reform + quality component + payment reform • Value based care doesn’t describe ... measured in several different ways: Total cost of care MLR Targets Medical Cost Trend Targets And ...
Description: Shared savings deals are all the rage these days. Significant numbers of payers and provider groups in many markets around the U.S. want to engage in shared savings contracts covering commercial, Medicare and Medicaid patients. The fundamental question underlying a value-based contract is, for whom is the value accruing? Ostensibly, value is accruing to the sponsor—whether employer or public payer—but should be accruing to the provider as well. Often design flaws in value-based arrangements and contracts and/or the inability to execute in a value-based paradigm diminish the savings that could have accrued, create inequities in value or drive unintended consequences. This presentation will provide attendees with insights into how to design a workable value-based payment initiative, how to educate both payer and provider participants, and how to oversee the initiative’s operations. Specific topics will include: • Attribution logic: prospective, retrospective and the details in between • Risk adjustment: why one model doesn’t fit all arrangements, and even if it does, how do you implement? • Data and reporting: matching business needs to the payer’s willingness to be transparent and provider capabilities • Quality improvement as a component of payment: actionable and tied to the attributed population or just “out there?”Hide
- Authors: Nathan James Baehr , Aaron Jurgaitis, Richard Lieberman
- Date: Jun 2019
- Competency: Strategic Insight and Integration
- Topics: Enterprise Risk Management
Medicare Advantage Benefit Flexibilityflexibility in tailoring benefits to promote clinical, care management, and financial goals. In this webcast ... 2020. Beneficiaries, Health Insurance, Managed Care, Medicare, Product Development 17738 1018 11/27/2019 ...
Description: Beginning with the 2019 Benefit Year, CMS (the Centers for Medicare and Medicaid Services) has provided guidance that allows Medicare Advantage Plan Sponsors, much greater flexibility in tailoring benefits to promote clinical, care management, and financial goals. In this webcast, we'll hear about how Plan Sponsors are incorporating innovative benefits into their MA plan offerings in 2020.Hide
- Authors: Nathan James Baehr , Michael Adelberg, Andrew Parker
- Date: Nov 2019
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration
- Topics: Health & Disability; Public Policy