Decisions by Scope: Program, Network, Beneficiary Cohort
Simulations of expected benchmark, shared savings, cash flows and risk exposure are performed for different decision scopes…
PROGRAM Different accountable care models (MSSP, GPDC, MA, etc.) and program / track selection options (such as BASIC vs ENHANCED track, prospective vs retrospective assignment methodology, etc.). Financial components includes gross and net shared savings, fee-for-service revenues, capitation payments, and negotiated discounts.
NETWORK Adding and removing provider participants at TIN or NPI levels, preferred provider arrangements for post acute care and specialists, and referral pattern alternatives across your contracts.
BENEFICIARY Different beneficiary attribution and churn strategies based on demographic, geographic or diagnosis-based patient cohorts. Includes impact of prospective vs retrospective assignment methodology and considerations for enrollment and voluntary alignment campaigns.