HCAS supports providers and ACOs in evaluating, monitoring and managing the risks under various contractual arrangements with payers. With the recent trend in contracts transitioning from traditional fee for service arrangements to innovative payment methods and value-based contracts, it is essential for providers to understand and effectively manage the risks associated with these contracts. In support of managing this risk, HCAS partners with providers to help them understand the nature and extent of the assumed risk inherent in these value-based contracts and potential implications to their financial wellbeing.
Provider consulting services include:
- Evaluation of risk and financial performance under various contract arrangement including:
- Bundled payments/episodes of care
- Shared savings/risk sharing contracts
- Partial or full capitation contracts
- Utilization and cost analysis of the assigned population to stratify risk and identify target areas for population health management that have an impact on achieving improved outcomes
- Projection of performance relative to benchmarks and the resulting shared savings/losses
ACO consulting services include:
- Reviewing contracts with payers including evaluation of:
- The nature and extent of the assumed risk inherent in the contract and potential implications to financial wellbeing of the organization
- Benchmark targets
- Capitation amounts
- Attribution methodology
- Reviewing contracts between ACOs and their participating providers
- Cost and utilization reporting of the assigned population supporting:
- Evaluation of cost and utilization relative to benchmark targets
- Projection of performance relative to benchmarks and the resulting shared savings/losses
- Identification of target populations for health management
- Evaluation of provider performance within the ACO
- Allocation of shared savings/losses between providers