Accountable care organizations (ACOs) facilitate the shifting of risk from insurance companies to providers. For providers to manage their risk in this new environment, they need actuarial support and Milliman can help. We have expertise in risk-bearing arrangements and can apply that knowledge to provider groups in ways they have not had to do in the past. Using our claims-based analytics capabilities and user-driven interfaces, we can help ACOs explore the data they receive in useful and customizable ways.
Milliman has a large number of Medicare ACO clients across the country, and we advise on a range of topics. Milliman assists on issues related to Centers for Medicare and Medicaid (CMS) rules and regulations, benchmarking, and managing risk. Specifically, we help ACOs to:
- Understand CMS historical benchmarking capabilities
- Understand changes in CMS’ program policies
- Track ongoing claims to estimate potential savings or losses
- Break down spending to determine the categories where most cost occurs (i.e., inpatient, outpatient, physician, etc.)
- Compare spending to Milliman well-managed and loosely managed benchmarks to identify areas where there may be the opportunity to drive costs down
- Determine which of the many ACO programs is most beneficial given an individual ACO’s composition and historical performance
In the current healthcare environment, payers—including Medicare—are looking for ways to drive down spending. Milliman can help providers navigate this current, complex risk-sharing environment.