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.
If you’re not focusing on your provider selection in a fast changing VBC market, your organization is falling behind. Whether you are a small ACO, new to taking on financial risk, or a large and profitable ACO eyeing new opportunities, your strategy should include evaluating your provider selection and expanding your organization’s network.
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.
ACOs often stand to benefit from moving to greater downside risk. However, this move is difficult to undertake if ACOs aren’t yet sure of their success in the prior year. Having a more accurate performance forecast in hand would allow successful ACOs to move confidently into greater risk (and reward) tracks.
Understanding the specifics of an ACO contract’s attribution methodology and the nuances that vary from contract to contract is key to ACO strategy and success.
Being able to explain track decisions to providers, investors, and other health system leaders strengthens the position of ACO leadership and sets up the organization for success.
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.
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.
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.