As MassHealth explains, “TA Domains reflect the areas of TA that MassHealth ACOs and CPs identified as TA priority areas during their first year of implementation.” In this blog post, we will dive deeper into a project related to the Actuarial and Financial domain, which is one of the seven domains that ECG has been selected to help with.
Actuarial and Financial Domain
The Actuarial and Financial domain, as defined by the MA DSRIP TA Marketplace, includes strategies for value-based payment:
- Design of global capitation billing and revenue models
- Practice/site-level support for developing risk-based financial and data infrastructure
- Alignment of provider incentives with alternative payment methodologies
Actuarial and Financial projects can take on many forms. One project we’ve completed in this area was an ACO development engagement with Northern Arizona Healthcare (NAH) in Flagstaff, Arizona.
In 2014, ECG worked with NAH to align its CIN and community physicians and create a structure that would allow it to collaborate with competing health systems as a commercial and Medicare ACO. We worked with NAH’s team on the development of a shared savings arrangement between the newly formed ACO, called PathfinderHealth, and NAH’s self-insured employee health plan. We assisted NAH in determining the total cost of care threshold for shared savings, the amount of care coordination fees to be paid to primary care providers (PCPs), and the shared savings distribution methodology between NAH and PathfinderHealth’s practitioners, among other financial elements of the arrangement. The arrangement resulted in a 6.3% reduction in costs for the employee health plan in its first year, along with material value-based incentive distributions to the PCPs in PathfinderHealth.
NAH and ECG partnered again in 2017 to support PathfinderHealth in preparing and applying for participation in the Medicare Shared Savings Program (MSSP) in 2018. ECG supported PathfinderHealth in the creation and facilitation of several committees, including the following:
- Finance Committee: ECG supported the Finance Committee by developing a funds flow for distribution of PathfinderHealth shared savings to providers and oversaw development of a PathfinderHealth budget, including the cost of operating staff, administrative expenses, supporting technology, and care managers.
- Data and Systems Committee: The Data and Systems Committee was responsible for defining the data-sharing requirements of the ACO participants and designing how data would flow through PathfinderHealth’s population health systems to support clinical processes and other ACO operations. ECG helped design the ways that data would be gathered by participating practices, integrated centrally, and disseminated to practices to support risk stratification, care manager clinical workflows, and performance improvement initiatives.
The MSSP application that ECG supported was approved by CMS, and PathfinderHealth recently completed its first participation year in the MSSP.
Have an Idea for a Project?
Learn more about ECG’s participation in the Actuarial and Financial domain and the MassHealth program on the MA DSRIP TA Marketplace website.