ACO Composition to Maximize Shared Savings

When: Friday, April 26, 7:30 – 8:15 am
Location: Key 11-12 
Speakers: Anders Larson, Cory Gusland, Colleen Norris, and Cathy Shea, Milliman 

Description: ACOs have organized, invested, and expanded. Now many face decisions about how they can optimize their performance in value-based contracts, particularly the Medicare Shared Savings Program. This presentation will focus on the technical approaches ACOs can use to improve performance, especially with respect to ACO composition. In particular we will discuss the following:

• Practical approaches to use claims data to determine what providers or TINs are making the greatest contribution to ACO success.
• Tools and techniques that can be used to promote financial success under the ACO program, particularly with regard to understanding benchmark and risk score adequacy.
• A discussion of how ACO composition impacts low revenue / high revenue status, the implications upon ACO renewal, and options an ACO might consider to be classified as “low revenue”.

The presentation will include a special focus on practical examples, so ACOs can leave with the framework for how to investigate these issues within their own organization. 

Speaker Bios:
Anders Larson, FSA, MAAA, consulting actuary at Milliman, provides actuarial consulting services to provider organizations, commercial and Medicaid health plans, self-funded groups, and state Medicaid agencies.  His experience includes financial projections, analysis of shared risk agreements, benchmarking of experience, fee schedule analysis and repricing, incurred but not reported (IBNR) reserve estimates, and research studies using large public data sources.  Over the last eight years, he has been significantly involved with provider payment reform and value-based reimbursement, working on behalf of ACOs, state Medicaid agencies, and private payers.  He previously served as the chair of the Predictive Analytics and Futurism Section Council of the Society of Actuaries. 

Cory Gusland, FSA, MAAA, consulting actuary at Milliman,has focused his career on creating sustainable health care financing structures that promote value based health care. His areas of expertise are alternative payment models, managed care, and provider sponsored health plans.  Mr. Gusland has experience working across commercial, Medicare and Medicaid populations. His current responsibilities include assisting health care providers and integrated delivery systems as they transition to risk bearing entities. Recent projects include the design and implementation of value based payment models, review of payer provider shared savings contracts, capitation payment analysis, provider reimbursement benchmarking, health plan feasibility studies, and cost and utilization projections for health care providers. 

Colleen Norris, FSA, MAAA, consulting actuary at Milliman,specializes in providing analytical and strategic support to organizations engaging in new models of reimbursing providers. She has helped both providers and payers develop quantitative approaches of understanding and measuring the spectrum of potential risk under a variety of potential arrangements. Ms. Norris' experience includes analyzing changes to provider reimbursement contracts to ensure consistency with desires goals, modeling risk transfers in reimbursement contracts, and developing strategic approaches to manage transferred risks.

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