In 2018, CMS announced a new program called Bundled Payments for Care Improvement – Advanced (BPCI-A). The program provided physician specialists the opportunity to manage episodes of care (EOCs) under a value-based payment framework.
A consultant at the time, I arranged for an early start up company to partner with a large revenue cycle management company and become a convener. I went through the lengthy application process on our collective behalf and recruited three practices to participate through us. The rigid framework of BPCI-A offered limited potential to redesign EOCs and – as a new program – very few insurers were interested in taking on the risk. The seeds for a revolutionary value-based risk brokerage and consulting firm were planted.
BPCI-A mainly teaches physicians and conveners how to leverage data to better manage post-acute care. With a goal of preventing complications, the connection between financial and professional liability became clear. Convincing the medical professional liability (MPL) industry of this connection would not be easy.
When CMS announced the Oncology Care Model (OCM), a new opportunity to partner with sophisticated underwriting teams emerged. Our small group studied the details of OCM and began speaking with the most advanced and innovative leaders in oncology. We engaged specialists in data analytics, predictive modeling, risk adjustment and actuarial science.
Before long we were building an advanced, proprietary pricing model. Though the MPL industry remained on the sidelines, we convinced stop loss underwriters to work with oncology groups willing and able to take “two-sided” risk. Deep Risk Management, LLC (DRM) was taking shape.
DRM was officially announced in 2021. One of the largest stop loss insurers in the US blessed our underwriting model and gave us an exclusive program. Our closest oncology partners signed on with us and continued educating us on oncology care.
A change in President brought in a new administration with new beliefs on “value-based care.” A bigger emphasis was placed on primary care and population health models to address specialty care. With OCM’s successor program in flux, ACOs and DCEs moved to the forefront.
DRM responded by upgrading our data analytic capabilities. We built new relationships – connecting people and continuing to connect dots for our partners and MPL colleagues. Our close ties with specialists provided us with unique insight into managing specialty care under a population health model.
Years of experience in healthcare risk contributed to DRM’s quick rise to the top of the value-based risk industry.
Our expertise spans population health and EOCs; government and commercial payor programs; collateral requirements; and the intersection of financial and professional risk management. DRM is building a national value-based risk marketplace. Participation – particularly from the MPL industry – is growing as expected.
We are just getting started.
If you are an innovator in value-based care or just interested in learning more, please reach out. We welcome conversations and partnerships with more of the best and brightest in healthcare.
Brian S. Kern, Esq.
DRM coordinates, and helps clients navigate, several highly complex fields – delivering cutting-edge products and services. DRM can equip medical practices of all sizes with the tools to compete with even the largest systems – all while helping them understand expensive cost drivers and improve care coordination.