Thread by @RahulRajkumar11

For the #ACO wonks out there, we applied lessons from other existing or previous #ACO models to inform our approach for #BluePremier. Let’s go into a deep dive into the methodology here. [THREAD] /1

We’ll use risk adjusted, trended, historical baseline to determine shared savings/losses for the attributed population. In two-sided risk, we’ll apply a discount to ensure the plan and its ASO customers have savings even as we pass back higher amounts of savings. #HealthData /2

This fits our first lesson: meet providers where they are—try to move too fast and lose opportunity. Given this is our first broad scale total cost of care model with many of these organizations, need to start gradually. /3

1/2 Second, “prospectivity” is valuable: while our internal systems and existing processes required us to go out of the gate with a retrospective attribution methodology, we have been transparent with our ACO partners about our intention…/4

2/2 …To meet their stated desires to have a prospective attribution logic for year 2 and opportunity for members to select a PCP. We both think this gives them the best opportunity to know who the population actually is for whom they will be accountable. /5

For the same reason, we use a prospective regional trend, derived from 5 distinct regions within #NorthCarolina. Using a projected trend sensitive to regional medical dynamics allowed us to balance prospectivity with other factors likely to influence predicted costs. /6

3rd, we’re fighting rebasing by including the ACO’s prior year savings in a future benchmark. This increases the longevity of the program by attempting to at least partially sever the link between past performance and a future benchmark (cc @jmichaelmcwilliam @michaelchernew) /7

Fourth, we are dedicating serious dollars solely devoted to quality, full stop (1% of the benchmark). Even ACOs that don’t earn shared savings will still have an opportunity to earn these quality dollars. /8

And, quality performance helps to mitigate losses, should they occur (one of Pioneer ACO Model’s best features, IMO) /9

Overall, we’re trying to build a sustainable risk arrangement that allows our health system partners to take accountability for cost/quality for the members they are serving. And we are always thinking about the future! Come join us: bluecrossnc.com/about-us/caree… @fara
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