ACOs, bundled payments, pay-for-performance—to be successful at payment innovations, providers and clinical care organizations need to know their numbers, be able to monitor performance and structure appropriate contracts for each payer.
DGA Partners can help providers and risk-taking entities to create successful responses to payment innovations. When Medicare innovations inevitably spill over to other payers, DGA has the experience you need to deal with contracting in all payer arenas.
If you are developing an ACO, we can help develop targeted budgets for care of defined patient populations, which will provide for shared savings.
We can create a bundled payment program that meets CMS criteria and is built around defined episodes of high cost, high volume inpatient procedures, including determining the:
- Model and span of care
- Most financially attractive option
- Risk-adjustment mechanisms and gaining-sharing models
- Right discount level
We can check and reconcile final payment/savings computations prepared by CMS or by health plans.
For hospitals that are looking at P4P and other innovative payment mechanisms, DGA can help structure and negotiate a new contract or restructure an existing one to achieve the benefits of aligned interests. Our team can:
Assess contract terms
Determine the budget neutrality of a new payment methodology
Consider the impact of severity and similar adjustments
Evaluate physician fee schedules
Perform analyses to support the distribution of bonus pools
Determine which quality metrics and ranking systems will make a contract most beneficial for all parties
DGA Partners has the extensive domain knowledge, strategic perspective, significant skills in data analysis and management and deep understanding of clinical and financial issues to support you in achieving success with innovative payment systems.
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