Health Plans & RBOs

Health plans and risk-bearing organizations (RBOs) face increasing pressure to effectively manage and administer complex, multifaceted risk pool agreements and respond to stakeholder requests for risk pool funding.

As the health care industry moves away from rewarding providers for volume and shifts to rewarding for value, organizations need to embrace this paradigm change and thoughtfully prepare for it. In the complicated managed care environment, the risk-based health care model continues to rise in popularity. The model has significantly evolved since its development more than 25 years ago, and many organizations engaged in risk contracting lack the industry-based expertise to support developments and effectively manage their membership.

Our professionals have roots in Southern California, the epicenter for managed care and RBOs since they first rose to prominence. Immersed in risk-based health care for decades, our professionals understand how to make smart business decisions and find innovative solutions that drive growth and strengthen your bottom line.

How We Help

We can assist your organization with:

Who We Serve

We work organizations of all sizes including:

  • Accountable care organizations (ACOs)
  • Coordinated care organizations (CCOs)
  • Dental plans
  • Exclusive provider organizations
  • Insurance exchanges
  • Independent practice associations (IPAs) and medical groups
  • Knox-Keene plans
  • Managed care and service organizations
  • Medicaid health plans and Medicare advantage plans

Insights


Article
Learn how changes to the Medicare Shared Savings Program more easily allows health care organizations to transform to a value-based care organization.

Webcast
As CMS continues to promote alternative payment models and reward providers based on outcomes, value-based programs and reimbursement models are here to stay. This panel discusses success stories of providers and payers who have adopted value-based programs and are realizing success.

Article
A third-party administrator audit, sometimes called an administrative claims review, helps tribes create accountability, measure performance, and establish processes for quality improvements.

Article
Internal audits of risk-bearing contracts can help reduce a health care organization’s financial exposure.

Article
Learn how a benefit claims audit serves as a cost containment strategy to help ensure your company isn’t losing money to improperly paid claims.

Webcast
Join Moss Adams LLP and PPC Partner Plus Consulting, Inc. to learn how various claims audits can help achieve cost savings and performance goals for self-funded insurance plans.

National Practice Leader