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  #31  
Old 12-15-2018, 04:28 PM
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I haven't worked a lot with ACOs. The few situations I did work with were fairly narrow and the contracts with the provider paid the provider a portion of the PMPM difference from year 1 to year 2. What I saw in the results was that many of the high cost members who were managed by the physician had a decrease in cost because the high PMPM in year 1 was due to a one time event that was unlikely to repeat. The population that I was looking at also had about 15% of the members never even interacting with the physician group but that 15% was a significant portion of the payments to the physician group.

I agree that evidence is sketchy at this point. I also think that the administrative aspects of these programs are not well thought out at this point in time. I'm hopeful that this will improve over time.
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It is/was always a struggle working in an organization where upper management wants savings, points to highly biased or pie-in-the-sky "studies" that show massive savings from ACOs, PCMHs, "evidence-based care", or some other brilliant overhaul, the medical management and provider relations folks are drooling over it because they get center stage, and then the actuaries just get to be the bearer of bad tidings, spending meeting after meeting pointing out that these studies have lists of faults.

Then the actuaries trot out the few legitamite honest studies, show that maybe up to 2% savings can be obtained, but the relationships with the providers will be destroyed through the changes needed to do that, so 0% savings is actually obtainable, and then the actuaries wind up not getting invited to key meetings. Then decisions get made, and a year and a half later, the actuaries get asked why there are losses. Repeat all of the prior year's conversations.
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  #32  
Old 12-15-2018, 05:44 PM
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YES

It is/was always a struggle working in an organization where upper management wants savings, points to highly biased or pie-in-the-sky "studies" that show massive savings from ACOs, PCMHs, "evidence-based care", or some other brilliant overhaul, the medical management and provider relations folks are drooling over it because they get center stage, and then the actuaries just get to be the bearer of bad tidings, spending meeting after meeting pointing out that these studies have lists of faults.

Then the actuaries trot out the few legitamite honest studies, show that maybe up to 2% savings can be obtained, but the relationships with the providers will be destroyed through the changes needed to do that, so 0% savings is actually obtainable, and then the actuaries wind up not getting invited to key meetings. Then decisions get made, and a year and a half later, the actuaries get asked why there are losses. Repeat all of the prior year's conversations.
So, you’re saying there is job security.
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  #33  
Old 12-15-2018, 08:45 PM
tommie frazier tommie frazier is offline
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YES

It is/was always a struggle working in an organization where upper management wants savings, points to highly biased or pie-in-the-sky "studies" that show massive savings from ACOs, PCMHs, "evidence-based care", or some other brilliant overhaul, the medical management and provider relations folks are drooling over it because they get center stage, and then the actuaries just get to be the bearer of bad tidings, spending meeting after meeting pointing out that these studies have lists of faults.

Then the actuaries trot out the few legitamite honest studies, show that maybe up to 2% savings can be obtained, but the relationships with the providers will be destroyed through the changes needed to do that, so 0% savings is actually obtainable, and then the actuaries wind up not getting invited to key meetings. Then decisions get made, and a year and a half later, the actuaries get asked why there are losses. Repeat all of the prior year's conversations.
so is the issue boiled down to providers need to be compensated differently (and likely less) and be ok with it? or that they need to change how they provide the services at lease?
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  #34  
Old 12-18-2018, 01:20 PM
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Late to the game, but most programs that trotted in front of our consultancy and claimed ROI were really taking credit for mean reversion, some in a more sophisticated manner than others.
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  #35  
Old 12-18-2018, 01:33 PM
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Late to the game, but most programs that trotted in front of our consultancy and claimed ROI were really taking credit for mean reversion, some in a more sophisticated manner than others.
Seriously? I worked in disease management from 2006-2011 and taking credit for regression to the mean was already a laughing stock. It's not that hard to get rid of that.

I guess people will always try to take the easy road, good on you for calling them on it though.
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  #36  
Old 12-18-2018, 01:54 PM
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I would be the only one in the room to say anything. One time the rep had to call an analytics guy and put him on speakerphone. The other actuaries weren't technical enough to understand (woo benefits)
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