NAACOS Boot Camp Agenda

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June 14–15, 2018
Nashville Airport Marriott
Nashville, Tenn.

Choosing the Right Medicare Track for Your ACO’s Success:
A Deep Dive into Assignment and Risk-Taking

General Information | Registration

Thursday, June 14

12:30 pm

Onsite Registration

1:00 pm 

Welcome and Introductions 

  • Quick introductions of faculty and attendees
  • Review of Boot Camp agenda, format and goals

1:30 pm

Overview of Medicare and Commercial Assignment (60 min)
Speaker: Travis Broome, Aledade 

Discussion of past policy changes that have affected ACO performance and what has been learned, including:

  • Comparison table of Medicare models
  • CMS migration from retrospective to patient selection of primary care provider
  • Policy recommendations from MedPac on downside risk movement, Advanced Alternate Payment Models (AAPMs), and end-game solutions for ACOs (Global cap, MA, NexGen)
  • Regional benchmarking: shift in AAPM / Merit-based Incentive Payment System (MIPS) episode costs vs. comparison of national benchmarking
  • Pitfalls of attribution
  • What tail and head winds are you aware of for making the risk decision?
  • Lost trend with consecutive years on performance
  • Lifetime value of the patient – defining success

2:30 pm

Key Drivers of ACO Performance  (60 min)
Speaker: Kim Kauffman, Summit Medical Group  

What are the key drivers of success in an ACO?  How do these relate to attribution?  How can the drivers be utilized to support ACO performance?

  • Medical cost per member per month (PMPMs)
  • Utilization
  • Risk adjustment
  • National trend vs. regional benchmarking
  • Physician specialty composition and patient acquisition (hospitalist, critical care, skilled nursing facility, pulmonary, primary care provider with rehab rounds)
  • Dual eligible special needs plan, chronic condition special needs plans, other valuable programs

3:30 pm

Break (15 min)

3:45 pm

LAB: Spotting the Right Strategies (75 min)
Facilitator:  Randy Cook, plus the Boot Camp Faculty

In this exercise, boot campers will use their data to identify the most impactful tactics that improve performance, including shifts to cost and utilization that produce strategic alignment, such as: 

  • Healthy attribution or annual wellness visit approach,
  • Risk adjustment factor (RAF),
  • Utilization management,
  • Specialist steerage,
  • De-attribution through outside lab data,
  • Post-acute care future costs. 

5:30 pm



Friday, June 15

7:30 am


8:00 am

Get on Track: How to Select the Right Track for You (90 min)
Speaker: Amy Kotch, Salient ACO 

What Are Your Options:  Other Tracks, NextGen, Medicare Advantage, Close Your ACO?

  • Compare and contrast Track 1+, 3 and NexGen
  • Risk adjustment changes in 2017
  • Medicare Advantage and global cap deals with commercial plans

9:30 am

Break (15 min)

9:45 am 

Case Study: Considerations when Deciding to Take Downside Risk (75 min)
Speaker: Stephen Nuckolls, Coastal Carolina Quality Care 

Hear about Coastal Carolina’s evolution from Track 1 to 1+.  Learn how this ACO evaluated its options and ultimately decided to take on risk.  From this ACO’s experience, gain understanding of the necessary changes to succeed in a risk-based track.

  • Regional calculations Track 1+:  Why and how?
  • Track 3 decision: Reinsurance
  • Probabilities of success with trends
  • Retrospective vs. prospective: PMPM impact, RAF, patient churn
  • Physician engagement for preparing for risk or reform ACO
  • MIPS bonus, built in gain between performance years that lower PMPM 

11:00 am

From ACO to PHSO: Time to Grow Up (60 min)
Speaker: James Dold, Lumeris Healthcare 

Learn how to measure your ACO’s risk and your providers’ risk readiness with discussion of the following elements:

  • Risk pools
  • MIPS / AAPM value
  • Unit economics
  • Physician compensation alignment
  • End game discussion:  Full cap, partial

12:00 pm

Lunch and Networking (60 min)

1:00 pm

LAB: Using the Monte Carlo Method to Measure Risk (75 min)
Facilitator: Colleen Norris, Milliman 

In this hands-on lab, boot campers will experiment with estimating risk by using the Monte Carlo Method, which is a simulation technique often used to understand the impact of risk and uncertainty in forecasting.  In addition, the following will be reviewed.

  • Economic principles
  • Actuarial pricing assessment to downside risk decision
  • Public health risk assessment for large populations
  • Likelihood of beating national or regional trend (Cost, RAF, Quality), based on QRUR reports

2:15 pm

Break (15 min)

2:30 pm

Operational Steps to Success in Downside Risk (75 min)

Speaker: Scott Disch, SolveMed Consulting 

This culminating session will discuss strategies for implementation and ongoing success in risk-based models, including these critical considerations.

  • Process vs. outcomes
  • Steerage vs. utilization
  • Provider risk pools and rubric for selection
  • Documentation vs. automated RAF
  • Pathways vs. medical decision support
  • Patient engagement vs. decision aids and self-management

3:45 pm

Wrap Up (15 min)

4:00 pm