Provider Risk Analysis, Contracting, and Operational Design

The Affordable Care Act introduced the ACO model to give health care organizations an incentive to use innovative mechanisms for coordinating care and integrating delivery. Many hospitals and health plans are already starting to develop and adapt to systems in which provider accountability, risk management, shared savings, and performance measurement are critical. But accountable care is a concept, not a model, and organizations will take different routes to achieve effectiveness.

Whether you’re looking to dip your toe in the water by implementing a bundling program or are ready to analyze taking on full risk, we bring decades of experience to help those looking to enhance or perhaps just sustain their organizational effectiveness. Our services include:

  • Strategic planning
  • Provider risk readiness assessments and performance enhancement
  • Operational design and implementation
  • Shared savings and bundled payment assessment and development
  • Licensure acquisition, such as California Knox-Keene licenses
  • Contract assessments and negotiation support
  • Hospital, medical group, and payer collaboration and integration
  • Incurred but not reported (IBNR) model development and reserve adequacy analytics
  • IT system assessments, design, and selection for payer, hospital, and group systems
  • MSO selection assistance and operational reviews
  • Physician and hospital revenue cycle management assessments
  • Provider network development and network sufficiency assessments

Primary Contact