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

2. Copyright Windsor Strategy Partners 2016
Our Agenda
Introductions
About WSP
Some examples of ACO-type engagements
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3. 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

4. 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

5. 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
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6. 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”
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7. 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”
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8. 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

9. 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

10. 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

11. 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
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12. Community-based medical plans
Competitive analysis
Plan design
Pricing versus provider reimbursement
Underwriting support
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13. 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
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14. Copyright Windsor Strategy Partners 2016
  Spencer J. Collum President Phone: website:   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 or the information contained in it is strictly prohibited. 
Copyright Windsor Strategy Partners 2016