Beneficiary Attribution Management

Why is it important to have a beneficiary attribution strategy?

At the center of every ACO are the patients they serve. The accurate attribution of these individual patients, or beneficiaries, can make or break the success of your organization. Having a beneficiary attribution management strategy is essential to identifying beneficiaries at risk of de-attribution and to opening doors for the attribution of additional beneficiaries. It also helps to avoid unintended attributions, which can be costly.

All of this sounds logical. But, how does one go about managing beneficiary attribution? Should we look at the data from years past? Projections that predict what our beneficiary population will look like in the future? Often, the biggest challenge in developing a strategy for beneficiary attribution management is determining which methodology–prospective or retrospective–will optimize long term shared savings.

How can you determine whether prospective or retrospective assignment methodology is best for your organization?

Validate Health starts by identifying beneficiary assignments to different provider levels: TIN, practice, or NPI. Separating the assignments into different levels allows us to more clearly see where high-cost and uncontrollable patients are being attributed. Then, we investigate and identify reasons for unexpected attribution of high cost or uncontrollable patients. These could include assignment eligible claims after a skilled nursing facility (SNF) discharge or during a visit to a specialist.

Finally, we examine the likely impact of voluntary alignment on overall shared savings. We identify which population segments are ideally suited to the strengths of your ACO and could benefit from outreach for annual wellness visits (AWVs).

What if I work with a small ACO?

Throughout the process, Validate can help monitor the data for smaller ACOs to avoid the risk of de-attributing too many beneficiaries, which can be costly.

How will COVID-19 affect my ACO’s metrics?

Validate has implemented certain enhancements to our products and services which help ACOs and other value based care organizations cope with the added complications of COVID-19. For example, relationships between beneficiaries and their primary care providers (PCP) take into account the public health emergency’s expanded telehealth codes in order to more accurately portray patient-provider interactions and services or procedures rendered. We also examine the impact of increased telehealth activity on assignment. The increasing utilization of telehealth strategies to treat patients presents a myriad of opportunities for ACOs to increase alignment. A review of these opportunities with our experts is just what some ACOs need to get the ball rolling, expand telehealth and increase alignment.