Risk Management Client Profiles

Most physician practices participate in some form of shared-savings program, whether population health or an episode of care.  DRM can help physicians “elevate” their participation in such programs to enhance their revenue opportunities.

Examples:

1. A group participates in an “upside only” program with a private payor.  DRM can help groups negotiate benchmarks and price out downside risk (stop loss) to capture a higher upside.  Two-sided risk contracts often come with better access to data and more control over care coordination.
2. A group participates in a shared-savings program but does not have data analytics expertise.  DRM can facilitate relationships to demonstrate how the group’s performance relates to revenue, as well as clinical and financial risk.

Most physicians and healthcare entities cut their teeth on bundled payments through the BPCI-A Advanced program offered by CMS.  “Conveners” who held the contracts with the government quickly learned the value of the data and how to leverage it to identify opportunity and decrease variability. 

They also learned the importance of having a good stop loss/risk partner. 

DRM helps conveners identify both cost-saving and risk transfer opportunities. 

New options for risk transfer (stop loss/reinsurance) continue to emerge.  DRM is building out this new and complex marketplace, and even has its own exclusive stop loss program. 

Contact us for more information. 

Management services organizations (MSOs) and private equity firms interested in an eventual exit understand that a strategy based exclusively on volume and high fee-for-service rates is not as attractive as one that includes the ability to compete in a value-based world. 

Transparency and site-neutrality laws are finally leveling the playing field between physician practices and corporate medicine. While the changes offer unprecedented opportunity, they also threaten the status quo. 

DRM has experience working with the most innovative MSOs in the nation. To learn more about how we can support your value-based efforts and help position you for success, contact us. 

CMS is providing optional, specific stop loss coverage to DCEs – at a cost. Prior to making critical decisions on risk, DRM can assist your DCE with a complete cost/ benefit analysis. 

Due to limited enrollment, DCEs have become increasingly valuable. Whether your DCE is exploring its options to partner with risk-bearing entities or intends to take risk on behalf of its provider-partners, trust DRM to present the best the industry has to offer. 

The national public health emergency has given ACOs in the MSSP program considerable flexibility in taking downside risk.  What many ACO’s are learning – in hindsight – is that expenditures were often down during the pandemic.  However, the uncertainly at the time led many to forego downside risk.  

Stop loss is designed to reduce uncertainly and create more predictability for entities involved in two-sided risk contracts.  

DRM can work with your ACO to model stop loss options and ensure that all decisions related to whether to take risk are made only after thorough due diligence. 

(Read our comments to CMS on bringing back reinsurance/ stop loss as an acceptable form of collateral here: https://deepriskmanpro.wpengine.com/comments-to-cms/) 

Healthcare risk is finally at an intersection between professional and financial. A strategy based only on professional liability can leave the MPL industry vulnerable to competitors that understand the overlap with – and future importance of – financial risk. 

DRM has built best-in-class capabilities to support the healthcare risk industry understand and take financial risk. 

To learn more about DRM’s capabilities, contact us today. 

Also visit:  https://deepriskmanpro.wpengine.com/patient-safety/