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Get insights on CMS regulations, trends in Value Based Care, and other info to optimize the financial outcomes of your ACO.

NAACOS Discovery Call: Using your MSSP’s Q4 files to Estimate your PY 2023 benchmark

We discuss how to use the CMS benchmark estimation tool for forecasting.  For PY23 in particular, DME fraud might be a factor in your estimates.  We present our most recent, not previously published findings, regarding the timing of fraudulent claims and how it changes performance forecasting.

PC Flex ACO Town Hall: Incorporating the new Flex model into your PY25 MSSP decisions

With the announcement of the new PC Flex model available to MSSP ACOs effective for the upcoming performance year, you now have even more considerations to take into account. These decisions are in addition to the big ones facing ACOs related to regulatory changes with MPFS23-24.

Webinar: Optimizing PY2025 Early Renewal, Track and Participant Selection

This webinar covers the newest multimillion dollar decision: Whether to early renew to take advantage of the MSSP methodology changes defined in the 2023 and 2024 Medicare Physician Fee Schedule (MPFS23 and MPFS24), rebase your benchmark years, and eliminate the CMS HCC v24-v28 model version skew. We also added tactics to counter aggressive participant recruitment due to growth in M&A activity and multi-ACO aggregators and related considerations for determining the optimal ACO structure for participant changes. Finally, we’ll illustrate the expected impact of the new “Step 3” claims beneficiary attribution methodology on ACO financials.

Using Your PY 2022 MSSP Settlement for PY 2024 Decisions

This webinar will help you interpret your settlement report and learn how to leverage for decisions: frequently asked questions, surprises about national trends, and examples of settlement calculations. Since there is still time to make selections for PY 2024 (due September 5th), the webinar will dive into considerations for the decisions remaining: dropping participants, early renewal, track selection, assignment methodology, and MSR/MLR.

ACO Participant and Track Selection: Using TIN-Level Metrics to Make ACO-Level Decisions

With the Shared Savings Contribution approach, financial impact of practices that implemented care management workflows becomes evident, with the more engaged practices rewarded accordingly. Positive contributing physicians subsidized those who lowered the shared savings of the ACO. Example cases demonstrate potential far-reaching consequences of distribution strategy on long term sustainability of an ACO.

Targeted HCC Risk Coding Investment Based on Calculated ROI of Gap Closure

Risk scores are an extremely important piece of the MSSP shared savings formula. Despite this, risk scoring rarely gets the attention it deserves. That’s because optimizing risk scores can be much more That’s because the how, when, and whys of investing into risk scoring can have complicated answers. In this article we cover all the basics on effectively investing to increase risk scores.

Impact of the COVID-19 Pandemic on ACO Financials Under MSSP

While CMS exemption of COVID-19 related inpatient expenditures may decrease spending for ACOs, deferred care and outpatient costs associated with COVID-19 may still drive up expenses, leading to financial losses. In response, Validate has added to their services to include COVID-19 episode exclusions for more accurate updated benchmark calculations, risk score monitoring for optimal adjustment to the historical benchmark, beneficiary assignment adjustment for telehealth inclusion, and COVID-19 adjusted analytics.

Impact of the 2018 National Assignable Trend Factor on ACO Financials

Most ACOs do not use a sufficiently accurate national assignable trend factor. Even after recognizing the impact of national trend on shared savings, it is important to recognize that it’s still one of many inputs impacting shared savings. ACOs can improve their financials and mitigate risk exposure by proactively managing these inputs through multi-year scenario simulations.

Evaluation of Potential ACO Performance Bias from Retrospective and Prospective Assignment

This is the first study to simulate the prospectively and retrospectively assigned beneficiary populations for actual ACOs. Key metrics were evaluated for each of the 322 ACOs during the 2015 performance year. Despite significant differences between prospective and retrospective assignment, neither methodology shows performance bias.

The Importance of Calculating Shared Savings/Loss Contribution by Provider

With the Shared Savings Contribution approach, financial impact of practices that implemented care management workflows becomes evident, with the more engaged practices rewarded accordingly. Positive contributing physicians subsidized those who lowered the shared savings of the ACO. Example cases demonstrate potential far-reaching consequences of distribution strategy on long term sustainability of an ACO.

VALIDATE HEALTH

Validate’s platform helps you increase revenue, decrease expenses and manage risk to get your ACO’s finances under control.

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