HCSS Accountable Care Organization Assessment Model

1. HCSS will design a Financial Projection Model with a projected ROI. The model will be based upon client specific data and can include the Medicare Med Par files, with trending of actual results. Highlight key areas of financial concern related to the impact of the ACO model.

2. Scenario testing of the potential impact of cost containment initiatives (e.g. percentage reductions required to cover administrative costs, and profit/risk margins).

3. Review the implications of HCC risk scores. Maintain risk score data base of potential ACO patients. Determine patient specific trends by disease cohort.

4. For hospital based ACOs, determine the effective lost income due to potential impact of reduced admissions-calculate the effective per case/per day impact. This calculation will be part of the financial forecast/ROI impact.

5. Assist in the determination of required data systems, care management and other administrative functions, and resulting cost to manage the programs.

6. Establish specific required care management programs with specific savings target objectives. This will be determined from the client specific data points.

7. From the programs envisioned determine the trending in health care cost anticipated.

8. Access the level of risk that an ACO should initially take (e.g. two sided or one sided model).

9. Recommend downstream provider specific incentive models and real time reporting systems designed to hit the ACO target PMPM rates.

10. Recommend data systems that include EMR, Hospital, Lab, Claim files for upfront early indicator risk management. This will include a methodology to determine high cost patients, chronic care management-disease cohorts for effective PCP programs, post hospital transitional care management reporting systems and population management actuarial based reporting platforms.

11. Assess and integrate where feasible EMR-meaningful use project, quality measurement initiatives, private payer contracting with ACO development. Meaning, single administrative model to satisfy related initiatives.