Industry

‍Advanced primary care marketplace

Use Case

‍Shared savings model development

Challenge

‍Building a shared savings model for self-insured employer market

Advanced primary care (APC) operates within a value-based care framework. While CMS programs, such as the Medicare Shared Savings Program (MSSP), are demonstrating success in achieving Triple Aim outcomes, the lack of standardized commercial shared savings models, among other challenges, have created a significant barrier for self-insured employers to adopt this care delivery and incentive aligned contracting model. As a neutral third party, Aligned Marketplace looked to develop a novel shared savings model for the self-insured employer market, covering a network of APCs and aligning incentives among stakeholders—employers,
advanced primary care providers, and patients.

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Solution

Adapting principles of MSSP with novel risk-adjustment and benchmarking methodologies

Aligned Marketplace turned to Accorded to develop a risk model that would help align incentives among its three stakeholders. Aligned’s shared savings model adapts the core principles of the MSSP to make it applicable to self-insured employers and its member population. Commercial benchmarks are created using Accorded’s proprietary condition-based matching which inherently risk adjusts on the member-condition level. This allows Aligned to compare observed and expected cost of care, determine whether actual savings have been realized, and then appropriately attribute it to providers based on the risk profile of the population served. Aligned provided input on key attributes, including carve outs, member attribution, risk sharing rates, and trend analysis, which along with benchmarking data informed the design of the shared savings model.

Impact

Leading with data-backed conviction in the shared savings model

This actuarially rigorous and innovative shared savings model enables Aligned to neutrally foster aligned incentives around total cost of care savings, quality of care, and member access and experience. It is the first to market solution for self-insured employers to offer advanced primary care access to their employees across geographies through a unified shared savings arrangement. The design also takes into account Aligned’s diverse commercial populations and by implementing member-level benchmarking, it ensures a comprehensive and tailored approach to holistically view each member. Equipped with this novel shared savings model, Aligned Marketplace confidently engages with employers and APCs facilitating a shift away from the traditional fee-for service constraints ultimately improving quality and member access and experience while significantly reducing total cost of care.

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