ACOS

Succeeding in risk.

With deep expertise in alternative payment models (APMs) and standing up risk-bearing entities, COPE Health Solutions is the ideal partner for achieving your goal of planning, developing and implementing a robust and efficient ACO. A key component of this joint effort is our ability to help our clients evaluate their readiness for alternative/advanced payment models including actionable recommendations ready for implementation.

 

Our Approach

We collaborate with client leadership to first conduct a current state assessment and better understand the opportunities as an ACO. This assessment includes identification of strengths or gaps in network construct required to address the health and social needs of the attributed population.  The core tools, analytics and outputs are generated sequentially, ensuring each phase of work and associated outputs are validated and informed by client input and subject matter experts. This includes:

• Intake and normalization of claims data provided
• Baseline analysis of claims data through the ARC Suite to identify targeted clinical redesign opportunities
• Provision of financial funds flow and pro forma tool populated with claims data
• Report of key insights and recommendations for initial network, clinical and financial redesign opportunities
• An alternative payment contracting report, including recommendations regarding potential value-based reimbursement models and risk-bearing opportunities
• Roadmap for success on alternative payment models that leverages findings from payor market assessment and identifies potential gap-to-goal activities

We then assist with negotiations and establishing relationships with Managed Care Organization(s) (MCO) identified as appropriate partner(s) for your ACO development.  Our experts have a vast experience in developing managed care strategies, negotiating contracts, identifying and developing new business opportunities for hospitals, systems and providers with local and national payors for all lines of business (Commercial, Medicare and Medicaid).