By Gregg A. Masters, MPH
During the ‘risk download days’, i.e., from health plan to physician groups or networks and institutional health systems or hospital partners, whether via global percent of premium, or budget driven PMPM contracts, some of us used to joke that using healthcare actuarial data to manage forward clinical risk was like driving your car via the lens of a rear view mirror (note: this is the pre-‘Google car’ era).
In fact some of us even were known to whisper in these sessions that actuaries where kind of like accountants albeit with a ‘charisma bypass’, yet none us would consider for a nano second assuming the risk of these full risk global deals without the aid of a competent actuarial advisor.
One of those players then and remaining so today is Milliman who’ve recently published a briefing on the difference between those ACOs functioning under the terms of the Medicare Shared Savings Program vs. the more ambitious and perhaps flexible Pioneer program. This is an excellent primer on ACOs, including a summary of risk, incentives and associated performance benchmarks.