Library of Risk-based Thought Leadership Materials

Risk Based Contracting Framework

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Foundation level concepts, and a structure for discussing and analyzing risk based contracts.  This paper assists provider groups in configuring analytical efforts based on contract features and life cycle. 

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A Legal Checklist for risk based contracting

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What language should you avoid, or seek? And what do you need to have in place as you sit across the table from your first risk-based payer opportunity? 

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Actuarial checklist for risk-based contracting

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Do you really understand your patient population as well as your payer does?  And what changes in your network structure will actually improve referrals, or patient health?


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How do I decide?

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 What benefits should a group expect from risk-based contracting? Is it more important to protect or enhance a referral stream? Or simply getting a toe in the water for an inevitable new way of doing business?  Any scenario could contain challenges that might make a go-forward decision questionable.   

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Risk Based Contracting under ACO

A study of ACO organizational Models

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Is the effectiveness of care coordination improved, or reduced when a hospital is part of the ACO network?  Or do physician-driven structures enhance the ability to influence hospital behavior?  

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Coordination of Care across independent organizations

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Too often, joining an ACO is executed as an end in itself.  What case studies will show how to facilitate care coordination, both internally, and across disparate provider groups?  What technologies, organizational structures and training work?   

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Risk-based Coverage under Medicare ACOs

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ACOs come largely pre-packaged. For providers about to sign up to a multi-year commitment, what real options exist to effect financial outcomes?  

 

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Hospital / Inpatient based Risk based contracting

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Inpatient stays dramatically effect total cost of care, even outside primary care sphere of influence.  How can ambulatory providers help manage this largest cost component? 

 

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Which ACO management techniques really work?

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Anyone can talk about "best practices".  But is there any evidence about which concepts actually gain traction, and which fall short? 

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A study of ACO organizational Models

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Is the effectiveness of care coordination improved, or reduced when a hospital is part of the ACO network?  Or do physician-driven structures enhance the ability to influence hospital behavior? 

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Skillsets and organizational models

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Depending on where you are in the risk-based contract life cycle, new skills will clearly be needed.  When is it reasonable to contract, hire or train, and for what skills? 

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Reporting Deep Dive

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Each analysis needs a reporting tool.  For each report, we provide a useful arrangement of content, data sources and use cases around the decisions that will improve contract performance 

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Do I need data or technology upgrades?

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 Under what options are  practice management and EHR systems  adequate?  If not, what kinds of data or systems are necessary, and where do I get them?  

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Internal Audit of Contract Performance

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A compliance might make sense, particularly in cases where a payer has the right to conduct examinations of their own.  Providing performance analysis to a board of directors could keep everyone on the same page. 

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Practice structures and networks for risk-based success

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 Might you perform better under a new contract with the acquisition of new specialty group?  Or can you simply improve outcomes and financials with formal care teams?  What decisions will help enhance our network under new contract types? 

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Creating a risk-based contracting strategy

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 Are you more likely to profit from having more patients, or having more profitable patients?  What features are common in your market, and how might each effect needs for technology, skills or network changes?  


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Detail analyses for managing risk-based contracts

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 Each component of a risk-based contract will demand its own analysis.  We lay out a number of specific reports, data aggregates, and use cases for each.   



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