HealthExecWire



Establishing Actuarial Cost and Utilization Targets for ACOs Using Medical Management to Achieve these Targets

    Using ACO population data to build actuarial utilization targets that tie into financial budgets
      Benchmarking services that can be targeted for reduction
      Medical Management Gap Analysis (supply and demand side)
Leveraging resources to provide medical management services
    Best practice medical management operations

The Patient Protection and Affordable Care Act (PPACA) calls for the creation of accountable care organizations (ACOs) as a more cost-effective way of paying for healthcare. In order to succeed, ACOs will have to establish actuarial cost and utilization targets and use medical management to achieve those targets. This process of benchmarking and managing toward targets requires a delicate balance of actuarial and clinical know-how. This session, led by national experts Kate Fitch, David Mirkin and Cathy Murphy-Barron from Milliman, Inc., guides participants through a roadmap to Accountable Care Organization success with a detailed presentation addressing actuarial benchmarking, medical and operations management in an ACO setting.

Topics discussed include degrees of ACO risk sharing, ACO financial budgets and targets, medical management priorities, ACO utilization models, supply side medical management services, demand management services, benchmarking, global capititation, a case study, and more.

Participants will be able to:

Understand the process of using experience claims data for an ACO's designated population to build actuarial utilization targets that tie to the financial budget
Learn what impactable services should be benchmarked in claims data and targeted for reduction
Ascertain the critical services to evaluate in a medical management gap analysis (supply and demand side)
Identify current capabilities and resources that can be leveraged to provide medical management services build versus buy decisions
Examine best practice medical management operations
Consider ACO medical and operations management challenges highlighted by an ACO case study

Interested attendees would include:

C-Suite Executives
Medical Directors
Care Management Executives and Staff
Actuarial Executives and Staff
Managed Care and Revenue Cycle Executives and Staff
Operations Executives and Staff
Provider Network Managers and Staff
Provider Contracting Managers and Staff
Analytics and Informatics Managers and Staff
Strategy and Planning Executives and Staff

Attendees would represent organizations including:

Hospitals
Provider Networks
Medical Groups
Health Plans
Care Management Organizations
Business Process Organizations
Solutions Providers
Associations, Institutes and Research Organizations
Government
Media
Other Interested Parties

Individual Registration Fee: $225. Audio Conference CD-ROM: $40 for attendees; $285 for non-attendees after the event. Corporate Site licensing also available. Click here to register or call 209.577.4888.