The Journey Ahead on MSSP Pathways to Success: Milliman Final Rule Analysis and Implications

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The Journey Ahead on MSSP Pathways to Success: Milliman Final Rule Analysis and Implications 
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The December 31, 2018 final rule for the 2019 Medicare Shared Savings Program (MSSP) implements many of the “Pathways to Success” provisions detailed in the proposed rule published on August 8, 2018, with some modifications that may have a significant impact on a number of accountable care organizations (ACOs). The final rule creates a structured timetable for inexperienced ACOs to transition to downside risk, gradually increasing the maximum risk exposure as those ACOs gain more experience with the MSSP.

The new MSSP “Pathways to Success,” regulation accelerates the path for accountable care organizations (ACOs) to participate in shared risk arrangements while simultaneously softening key MSSP provisions, allowing lower revenue ACOs to participate with reduced total financial risk. In addition, CMS has put forth numerous methodological and operational changes.

With the MSSP final rule, CMS is offering greater shared savings potential to ACOs participating in the BASIC track and making the BASIC track available to a broader set of ACOs. The effect of these rule changes on specific ACOs will vary significantly depending on an ACO’s size, region, cost and quality performance, and structure. It is critical that ACOs fully consider all of the implications of these new rules in order to identify both the risks and the opportunities specific to their organizations. Time is allotted for attendee questions and answers during the session.

Please join us on Wednesday, March 13, 2019, at 1 PM Eastern as Milliman's Colleen Norris and Jason McEwen present Milliman's analysis of the proposed Pathways to Success program in the HealthcareWebSummit event: The Journey Ahead on MSSP Pathways to Success: Milliman Final Rule Analysis and Implications.
Cure for the Common Webinar

In addition to the main faculty presentation, this event includes a fun whiteboard drawing format opening video, a brief moderated faculty interview, and concluding live audience questions and answers. The day before the event, you'll receive login information, including downloadable companion presentation slides.

Just after the event, you'll receive a follow-up request for feedback, also offering an opportunity to provide any final questions that can be forwarded to the faculty. Also, if you need support before, during or after the event, you can contact HealthcareWebSummit staff at any time.

Learning Objectives

After attending this webinar, attendees will be able to:

  1. Identify the Final Rule key revisions to the proposed rule
  2. Understand the various elements of the new BASIC and ENHANCED tracks.
  3. Examine BASIC track use of revenue-based loss-sharing limits.
  4. Evaluate the criteria determining ACO track eligibility and at what level ACOs would enter the BASIC track "glide path."
  5. Consider changes to the benchmark calculation, including regional cost adjustment, risk adjustment, trend, and agreement period duration.
  6. Explore implications of the Final Rule for the Medicare Shared Savings Program and its stakeholders going forward.
  7. Engage in interactive learning through online question submission, attendee feedback and opportunity for follow up questions, and networking with attendees, faculty and other professionals through dedicated LinkedIn group.
Who Should Attend

Interested attendees would include:

  • C-Suite Executives
  • ACO Operations Executives and Staff
  • Provider Network Executives and Staff
  • Medical Directors
  • Finance Executives and Staff
  • Analytics Executives and Staff
  • Managed Care Executives and Staff
  • Revenue Cycle Executives and Staff
  • Planning and Strategic Executives and Staff
  • Legal, Regulatory and Policy Executives and Staff
  • Business Intelligence Staff
  • Other Interested Parties

Attendees would represent organizations including:

  • ACOs
  • Provider Networks
  • Medical Groups
  • Hospitals and Health Systems
  • Health Plans
  • Government Agencies
  • Life Sciences Organizations
  • Solutions Providers
  • Associations, Institutes and Research Organizations
  • Media
  • Other Interested Organizations
  Individual Registration Fee: $195. Post-event materials, with video of slides synchronized with speaker audio, plus presentation pdf file: $45 for attendees; $260 for non-attendees after the event. Register online or download the event flyer.
Register Now   Click here to register or call 209.577.4888. Corporate Site licensing also available. We look forward to your attendance!
Colleen Norris

Colleen Norris,
Consulting Actuary

  Colleen is a consulting actuary with the Denver office of Milliman. She joined the firm in 2008. Colleen specializes in providing analytical and strategic support to organizations engaging in new models of reimbursing providers. She has helped both providers and payers develop quantitative approaches of understanding and measuring the spectrum of potential risk under a variety of potential arrangements. Colleen's experience includes analyzing changes to provider reimbursement contracts to ensure consistency with desires goals, modeling risk transfers in reimbursement contracts, and developing strategic approaches to manage transferred risks.

She has assisted large provider systems with developing models for the appropriate transfer of financial risk to smaller provider units of providers, as well as has provided strategic and tactical planning for provider systems looking to optimize their long-term prospects in the era of increased risk-sharing.

She also has experience with Medicare ACO (MSSP & Next Gen) and MACRA risk impact assessments and strategic planning.

Colleen has experience with using predictive models to help organizations identify, measure, and monitor key risk factors. Her background also includes commercial healthcare benefit plan design, pricing, feasibility studies, and financial modeling. She has developed regulatory filings for health carries, developed underwriting and rating models, and has projected liabilities for incurred but not paid claims.

Colleen is a Fellow in the Society of Actuaries and a Member in the American Academy of Actuaries. She received her BS (summa cum laude) in Physics from Creighton University, and a MS in Physics, at the University of California, San Diego (UCSD).

Jason McEwen, FSA, MAAA

Jason McEwen,
Consulting Actuary Milliman

Jason is a consulting actuary with the Denver Health practice of Milliman. Jason assists provider organizations in navigating the ever-present world of value-based payments. He specializes in modeling and quantifying the risk associated with reimbursement contracts that differ from traditional fee-for-service arrangements. Jason has assisted provider organizations in determining the optimal Medicare ACO option to participate in and has evaluated the impact that different commercial ACO structures would have on the potential for shared savings.

Jason also has experience in commercial pricing. This includes pricing self-funded, large group, small group, and individual products in multiple states. He has assisted various companies in developing strategic rates to best compete in the marketplace. He has also reviewed and helped improve rating action guidelines on small-group self-insured products.

Jason’s background also includes many other areas of actuarial work, including projecting future risk adjustment payments on the exchange, projecting incurred but not reported claims, rate negotiations in Medicaid and USFHP programs, and Tricare bid development.

Jason is a Fellow, Society of Actuaries, and a Member, American Academy of Actuaries. He received a BS in Actuarial Science, with a Business Management minor, from Brigham Young University.

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