Managing Risk in a Value Based World | Capabilities | FTI Consulting

Managing Risk in a Value Based World

Health Solutions

October 29, 2015

More and more organizations are transitioning from a fee-for-service, volume driven care delivery model to one based on demonstrating value. Indeed, Leavitt Partners estimates there are 744 public and private ACOs across the US participating in some form of accountable care relationship. So, although the growth in value based care has occurred, the results have been disappointing at best. Recent results from the CMS MSSP program indicated less than one-quarter of the participating ACOs achieved the minimum shared savings threshold. Simply put, many organizations have discovered that managing populations in a value based, risk based world is challenging.

Managing Risk - The Challenges
Hospitals, health systems and physician groups have done a tremendous job forming clinically integrated networks (CINs), ACOs, accountable care collaboratives and other value based partnerships. These efforts typically include resources and investments made in physician alignment, population health, technology, analytics, care management and improved coordination with critical post-acute care providers. However, once up and running, managing the populations under risk has proved challenging. Some reasons for this include:

  • Inexperience in managing a total population, not just patients admitted to your facility
  • Data and Information Systems not designed for risk management purposes
  • Low number of patients/members in your risk pool Insufficient reporting capabilities to allow management to respond quickly and proactively
  • Lack of focus on the right initiatives
  • Aggressive risk models and targets
  • Lack of a payer contracting strategy

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