Wondering Where the Shared Savings Are?

Shared savings deals are all the rage these days. Many provider groups in markets around the U.S. want to engage in shared savings contracts with private payers covering commercial, Medicare-Advantage and even Medicaid patients. Payers are only too happy to participate. Shared savings transfers a substantial amount of the financial and underwriting risk to the providers, increasing the likelihood that even larger surpluses will accrue to the payers than under traditional volume-based fee-for-service contracts.

On the surface, implementing a value-based program may look simple— identify a population of patients, figure out what you spent last year on that group, and if the provider group spends less on those patients next year, while at the same time maintaining or improving quality of care, both the payer and provider group will share in the savings.

If only what appears to look so easy were indeed really that easy! Physicians often erroneously believe that they know how to make the most cost-effective decisions on behalf of their patients, and that they will always make the optimal decisions that will both improve their patient’s lives while at the same time save everybody money and generate significant surpluses for the members of the ACO. Just get the insurance company out of the way and everybody benefits! Right?

Wrong. Shared savings programs are hard. The Mile High team knows this because we are right in the thick of it, working to prevent ACOs and payers from “killing each other.” In some cases, we serve as reporting and reconciliation vendors, transparently reporting shared savings performance to both ACO and payer. In other situations, we represent just the ACO as they try to stand up a new shared savings initiative that will work for both the ACO and the payer.

Then there is the least desirable but often necessary role in which we serve. When the ACO deal wasn’t set up properly in the beginning and now the parties are lawyer-ed up. In this situation, Mile High has successfully worked to keep the warring parties out of litigation by recalculating shared savings retrospectively and promoting out-of-court settlements.

At Mile High Healthcare Consulting we are acutely aware that over the years, organizations have wasted millions of dollars on consultants who delivered recommendations that could not be practically implemented, and that is not what we are about.

Where is your organization on the value-based program continuum?

Just Starting to Think About Value-Based Payment

Value-based payments (VBP) still a thing of the future? Does your organization know that VBP is coming but doesn’t really know how you will begin the process? Are the payers insisting on VBP deals that your organization doesn’t really understand?

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Do We Have to Take Downside Risk?

Not sure your organization is ready for downside risk? Let the experts on the MHHC team perform an inspection before it is too late!

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Something Has Gone Wrong!

Shared savings not what you expected them to be? Payer appears to be changing the terms of the deal mid-stream? Risk scores don’t seem to make sense?

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Have Questions? Contact Us Today!