Accountable Care Organizations, a Financial View
Course Overview
Presenter: Juliet M. Spector, FSA, MAA
Milliman
According to the Centers for Medicare and Medicaid Services, Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.
The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.
But will it work, both structurally and financially? Can their organization support non-Medicare patients as well as Medicare patients?
This course will explore ACO’s as they have grown; it will look at their key concepts, what failed before, how, and why it might work this time. The course will also present the implications to providers as they consider joining an ACO. All of the course material will have strong financial insights.
Time to view the course is 20 minutes.
Course Learning Objectives
At the conclusion of this course the learner will understand:
- Why ACO’s have not been successful up to today.
- What is new this time around and why it could work.
- Where the savings would come from to make ACO’s financially viable.
- The cost of the infrastructure required to do it and how to offset the costs.
- What the financial benefits would be if everything goes right.
- What could go wrong.
- The financial risks and other issues to consider.
- Are ACO’s the answer.
Time to complete the course is approximately 45 minutes.
Presenter: Juliet M. Spector, FSA, MAA
Juliet offers guidance and experience to both providers and insurers in understanding and estimating the complex financial risks associated with healthcare costs.
Juliet lends actuarial expertise to enable providers to understand a patient-centered quality care delivery system. She develops customized actuarial cost models to allow her provider clients to maximize revenue when implementing changes to reimbursement strategies or capitation rates. She develops customized utilization and cost benchmarks to enable a focus on quality of care and best practices. She has experience analyzing and pricing bundled payments and doing longitudinal analysis of specific disease states. She helps providers with commercial, Medicare, and Medicaid reimbursement arrangements.
Developing Organization: Milliman
Milliman is among the world’s largest providers of actuarial and related products and services. Founded in 1947, Milliman is an independent firm with offices in major cities around the globe. They are owned and managed by their principals—senior consultants whose selection is based on their technical, professional and business achievements.
Milliman serves the full spectrum of business, financial, government, union, education, and nonprofit organizations. In addition to their consulting actuaries, Milliman’s body of professionals includes numerous other specialists, ranging from clinicians to economists.
Despite their impressive growth over the past six decades, they still operate according to the guiding principles of their founders, Wendell Milliman and Stuart Robertson. They retain their rigorous standards of professional excellence, peer review and objectivity. They remain committed to developing innovative tools and products and providing expert solutions. And they continue to earn their clients’ trust by keeping their focus fixed on their clients’ business objectives.