Wakely, an HMA Company, has actuaries and consultants that offer an in-depth understanding of value-based payment models from the perspective of both health plans and delivery systems. Accountable Care Organizations (ACOs) will benefit from the increased understanding of their at-risk membership that actuarial analysis can provide. We are well positioned to help ACOs and value-oriented provider groups navigate value-based payment models.
The four services below can provide a foundation for ACOs to better manage their risk profiles.
WNOT
Optimize your financial opportunities within your ACO with the Wakely Network Optimization Tool (WNOT), designed to support risk-bearing health systems in identifying the efficient and non-efficient providers to curate their network. In addition to providing historical experience on providers of interest, the tool also supports future year shared savings projections as ACOs update their participating providers and groups.
Wakely Financial Projections
Wakely forecasts likely results for the performance year and under the ACO’s Medicare Shared Savings Program (MSSP) track using the data provided by CMS (quarterly reports, annual settlements, benchmark reports, Claim and Claim Line Feed (CCLF)) along with the current list of providers. The forecast will include a confidence interval around the results based on Monte Carlo simulations to demonstrate general sensitivity of the projection.
Provider and Member-level Performance Scorecards
These models are intended to be complementary to our forecasting tools and allows ACOs to understand what providers, or provider groups, and specific members are contributing to an ACO’s favorable or unfavorable performance. The modeling uses an ACO’s CCLF data and other CMS reports to bring a forecasted or final settlement benchmark down to a provider and member level.
Medical Economics Model
Wakely uses an ACO’s CCLF and other CMS reports to create trend analysis, cost and utilization modeling, and other population health metrics to derive insights on an ACO’s areas of performance strength and areas of potential opportunity to focus operational and clinical teams for improvement initiatives. The model uses benchmarks from our Medicare data sets to develop fee-for-services and managed Medicare benchmarking at a service category level to help ACOs understand their magnitude of opportunity. The model allows ACOs to view performance by various cohorts, at varying levels of granularity, and groupings of providers.
Risk Adjustment Performance Reporting
Wakely uses an ACO’s CCLF and other CMS reports to create risk score accrual curves looking at the risk score development of your current population, chronic condition revalidation rates, suspected opportunity reporting, and v28 risk adjustment model impact reporting. This package of reports allows an ACO to understand if their initiatives around accurate clinical documentation and coding are producing intended results. Similar to the Medical Economics model, the reporting allows ACOs to view performance by various cohorts, at varying levels of granularity, and groupings of providers.
