Session 124PD: Risk-Adjustment and Related Issues in Episode-Based Paymentsactuaries love acronyms ACH – Acute care hospital ACO – Accountable Care Organization AMI – Acute Myocardial ... Bundled Payments for Care Improvement Model BPCI Advanced – Bundled Payments for Care Improvement Advanced ...
Description: "The Centers for Medicare and Medicaid Services (CMS) has implemented a variety of episode-based payment models. Each model has a unique financial risk profile based on episode definition, implicit and explicit risk adjustment and other features. Of particular interest, are the various ways risk adjustment is handled in these different models. Attendees will learn about the different risk arrangements and how the actuarial skill set is relevant to value-based payments. Additionally, real life examples will give insight into the practical application of these models. Ultimately, attendees will come away with a deeper understanding of key methodological issues that can apply not just to Medicare but across the healthcare spectrum as the transition away from fee-for-service and toward value-based reimbursement continues.At the conclusion of the session, attendees will be able to:• Demonstrate knowledge of CMS episode-based payment models and their risk features;• Apply actuarial insights to value-based payment methodologies; and• Understand value-based payments from the provider perspective."Hide
- Authors: Thomas Snook, Kathryn Elizabeth Rains-McNally, Lili Brillstein, Samuel Bennett
- Date: Oct 2018
- Competency: Strategic Insight and Integration
- Topics: Health & Disability>Payment models; Public Policy