Actuarial Support For Healthcare Providers November 22, 2016 Windsor Strategy Partners Copyright Windsor Strategy Partners 2016

Copyright Windsor Strategy Partners 2016 Our Agenda Introductions About WSP Some examples of ACO-type engagements Copyright Windsor Strategy Partners 2016

About Windsor Strategy Partners Healthcare actuarial consulting firm founded in 2004 Clients include all manner of healthcare risk taker: Reinsurers, Insurers, Managing General Underwriters, captive insurers, hospital systems, ACOs, Managed Care Organizations, physician organizations, Third Party Administrators, brokers, consulting firms, Multiple Employer Welfare Associations and government agencies Windsor Strategy Solutions formed in 2015 Separate focus on our software solutions Copyright Windsor Strategy Partners 2016

What can we do for provider organizations? Risk Readiness assessment Assessment of risks in contracts ACO monitoring and forecasting for Medicare Shared Savings Managed Care pricing and contract modeling Evaluation of managed care contract offerings Street level competitiveness Strategies for minimizing bad debt Community-based medical plan development Assessment of risk mitigation strategies Copyright Windsor Strategy Partners 2016

Risk Readiness Assessment Understanding risk contract requirements Identification of skill sets required to perform contract requirements Dealing with data asymmetry Data and systems required Evaluation of strategies to be successful Risk mitigation Proper risk adjustment Copyright Windsor Strategy Partners 2016

Assessment of Risks in Contracts Any new contract from a network has risk somewhere Could be a hidden risk such as bad debt Could be a performance standard that is seemingly in reach but isn’t Could be an attribution risk Could be risk for products and services not within the management control of the contracting entity Reimbursement isn’t always what it seems to be Sometimes “less” is “more” Copyright Windsor Strategy Partners 2016

ACO Monitoring and Forecasting for Medicare Shared Savings Avoid financial surprises for Management and Boards Analyze the “Encore Problem” Project shared savings results for current and future periods Financial Model Simulation model Answer strategic questions Develop the financial foundation to assess the risks of going “full risk” Copyright Windsor Strategy Partners 2016

Where does the data come from? Uses quarterly reports from CMS Provided by the ACO or obtained directly from CMS Individual member level medical expenditure data from the ACO

What does the model do? Forecasts the benchmark for the upcoming contract period Forecasts the expected shared savings (loss) for the ACO Allows for what-ifs on the following variables: Benchmark  Trend Utilization changes Enrollment changes Risk changes Quality score changes Forecasts the impact of combining two or more ACOs vs. keeping them separate for M&A purposes

What does the simulation allow us to do? Simulation uses the distribution of annual beneficiary expenditures by enrollment type tailored to each ACO Shows the likelihood of achieving shared savings (loss) Shows the distribution of shared savings (loss) outcomes Simulation allows for what-ifs on the following variables: Benchmark Trend Utilization changes Enrollment changes Simulations show the likelihood of a combined ACO doing better than the separate ACOs

Managed Care pricing and contract modeling Evaluation of managed care contract offerings Street level competitiveness Strategies for minimizing bad debt Plan design versus contracting – understanding tradeoffs The ACO Contracting Tool Based on the WSS Actuarial Advisor Model Copyright Windsor Strategy Partners 2016

Community-based medical plans Competitive analysis Plan design Pricing versus provider reimbursement Underwriting support Copyright Windsor Strategy Partners 2016

You can’t manage what you can’t measure! Risk Mitigation begins with data Avoid bad deals Identify the “gotchas” when dealing with commercial carriers Identify risks that need to be reinsured Buy the right kind of protection Copyright Windsor Strategy Partners 2016

Copyright Windsor Strategy Partners 2016   Spencer J. Collum President Phone: 954.347.1555 Email: spencer@revcureconsulting.com website: www.revcureconsulting.com   RevCure Consulting is a healthcare sales consulting firm based in Ft. Lauderdale, FL. Specializing in the group health industry, RevCure educates potential clients about new, successful and innovative healthcare services. If you would like a summary of our vendor partners and their services please click here.         CONFIDENTIALITY NOTICE: The information contained in this message and any attached document is intended only for the personal and confidential use of the designated recipient(s).  This message contains confidential and privileged communications.  If the reader of this message is not the intended recipient (or an agent responsible for delivering it to the intended recipient), you are hereby notified that any unauthorized distribution or copying of this email or the information contained in it is strictly prohibited.  Copyright Windsor Strategy Partners 2016