Health Fidelity | ACO eBook Part 2: Staying Ahead of the Curve: National Risk Trends and Their Impact on Care Funding

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Think a +3% Benchmark is Enough? It’s Not.

Medicare ACOs need to set their sights higher than 3% to obtain complete and accurate risk adjustment.

Even among healthcare organizations that consider themselves experienced at addressing risk, many focus on reaching the 3% improvement cap over the prior year’s benchmark as an annual goal. While this is an excellent first step, risk-based payment calculations include multiple variables, including economic inflation and an ever-variable coding intensity factor that means a 3% YOY target is much, much too low.

And if your target is too low, the downstream consequences of an incomplete and inaccurate risk profile are significant:

chronic conditions are being left un-or-under documented, hamstringing physicians from creating effective care plans inclusive of all comorbidities
potentially millions of dollars of care funding go unclaimed, creating an increase in expenses

Our latest ebook, Staying Ahead of the Curve: National Risk Trends and Their Impact on Care Funding, builds on part 1 (Pulling Both Levers), deepening the case for a systematic, year-round approach to risk adjustment. By exploring the broader calculations that need to be understood for effective annual planning, your organization will be poised to grow and thrive under value-based care.

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Connect with us to reserve a time during the conference. We look forward to seeing you in Nashville.

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Connect with us to reserve a time during the conference. We look forward to seeing you in Nashville.

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Leave with key takeaways and lessons learned that will enable your organization to succeed in similar circumstances.

Peer Perspective: UPMC Case Study

Mary Beth Jenkins, SVP & COO at UPMC HEALTH PLAN and Dr. Adele Towers, MPH at UPMC Enterprises will explain the challenges their plan was facing in risk adjustment for their MA and Exchange populations. Together, they'll discuss how they overcame several challenges and improved plan performance.

Leave with key takeaways and lessons learned that will enable your organization to succeed in similar circumstances.

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Even among healthcare organizations that consider themselves experienced at addressing risk, many focus on reaching the 3% improvement cap over the prior year’s benchmark as an annual goal. While this is an excellent first step, risk-based payment calculations include multiple variables, including economic inflation and an ever-variable coding intensity factor that means a 3% YOY target is much, much too low.

And if your target is too low, the downstream consequences of an incomplete and inaccurate risk profile are significant:

chronic conditions are being left un-or-under documented, hamstringing physicians from creating effective care plans inclusive of all comorbidities
potentially millions of dollars of care funding go unclaimed, creating an increase in expenses

Our latest ebook, Staying Ahead of the Curve: National Risk Trends and Their Impact on Care Funding, builds on part 1 (Pulling Both Levers), deepening the case for a systematic, year-round approach to risk adjustment. By exploring the broader calculations that need to be understood for effective annual planning, your organization will be poised to grow and thrive under value-based care.

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The Growing Influence of Risk Adjustment

While risk adjustment is an intrinsic element of healthcare in the US, critically important to upside and downside risk-sharing models alike, it is often overlooked as an opportunity to support revenue and better engage with patient care.

The ACO Algorithm Simplified

Historic expenses, risk adjustment, medical expenses, and quality: each an element of the bedrock ACO algorithm. In our new ebook, we unpack each element, how they interact, and their short- and long-term ramifications on revenue and benchmarking.

The Relationship between Cost and Risk

Cost reduction through increasingly better utilization management has diminishing returns. Risk adjustment is capped at 3% a year. Each alone can move the needle on revenue for an organization, albeit within its limitations. However, when effective utilization management is employed alongside accurate risk adjustment, the delta between cost and reimbursement, improving benchmarking and impacting short and long-term revenue.

Identify Your Performance Pattern

ACO Benchmark Performance Categories

In addition to offering insight into the algorithms that lead to care funding and the relationship between risk and cost, our latest ebook includes an analysis demonstrating it with real-world data from CMS. Controlling for short term variability, and population churn, our analysis illustrates four separate outcomes in performance year 1-2, based on benchmarks established in the prior two years (BY2-3). Every MSSP between 2014-2018 fell into one of these categories. Armed with this data and analysis, risk-bearing organizations can recognize their own circumstances and determine the best, strategic next steps for the coming years.

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Ut sed laoreet felis. Ut tristique ante orci, in blandit est scelerisque non. Vestibulum quis elementum enim. Phasellus congue pulvinar cursus. Nam hendrerit pellentesque malesuada. Vivamus dui tellus, tempus a fermentum at, eleifend ut ligula. Suspendisse quis augue vulputate ligula egestas ullamcorper.

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Download eBook Part 2

Staying Ahead of the Curve:

National Risk Trends and Their Impact on Care Funding

Please provide the information requested to the right. An email with the link to download a PDF of the eBook will be sent to your inbox.

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How can Health Fidelity best serve you?

Think a +3% Benchmark is Enough? It’s Not.

Medicare ACOs need to set their sights higher than 3% to obtain complete and accurate risk adjustment.

Evaluate

Compare

Inquire

Peer Perspective: UPMC Case Study

Monday, March 21 at 2:00PM

The Growing Influence of Risk Adjustment

The ACO Algorithm Simplified

The Relationship between Cost and Risk

Identify Your Performance Pattern

Monday, March 21 at 2:00PM

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Integer sollicitudin tincidunt ante eget rutrum

Proin sed est a sem

Download eBook Part 2

Staying Ahead of the Curve:

National Risk Trends and Their Impact on Care Funding