Tag Archives: Colleen Norris

Three-pillar strategy for value-based contracting

Healthcare providers can improve their financial performance under value-based contracts by implementing an effective contracting strategy. Milliman consultants David Williams, David Liner, and Colleen Norris discuss how providers can accomplish that by prioritizing and measuring operational and contractual elements against three core pillars: transparency, stability, and control. Here is an excerpt from their article “Building a successful value-based payer contracting strategy.”

Providers prioritize each pillar and attribute to create weights for each cell. Contractual elements are then evaluated against those pillars to produce a score for each cell. This can be either a subjective evaluation or a more rigorous analytic evaluation depending on the nature of the element. The weighted scores can be used to prioritize areas of administrative concentration and to compare payer contracts on a similar basis. This prioritization is a critical step to a successful contracting evaluation process….

…The exercise of scoring the grid identifies high-risk elements and compares contract structures from different payers that require revisions. When performed rigorously, this process brings focus that allows management to spend more time on contracts with the greatest risk and potential for improvement. Applying each pillar to specific payer contract elements identifies specific risks and creates areas of focus for providers during negotiation. However, this analysis alone does not enable providers to easily compare value-based contracts in their entirety.

The complex evaluation process is illustrated below in a simplified form. The intent of this illustration is to highlight important aspects of the decision-making process required to effectively manage complex payer relationships.

First, the contract is scored for each pillar and element cell in the scoring grid. Each contract is evaluated separately and may contain different elements. The provider may require independent help.

Second, the provider weights each cell in the grid based on priorities. These weights would likely be consistent across contracts. The provider may counsel with outside help to prioritize, but ultimately will be responsible for the focus of their efforts.

Finally, the total score is calculated by applying weights in each cell based on prioritization of the contracting elements. Figure 2 illustrates this contract-scoring approach.

CMS announcement shapes MACRA implementation

norris-colleenOn September 8, Andrew Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), made a significant announcement on the CMS blog regarding the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) implementation timeline.

According to CMS, providers will be allowed to “pick their pace” with respect to the Quality Payment Program (QPP) in the first year of MACRA implementation. Mr. Slavitt has outlined four proposed “pace” levels in which providers can enter the QPP.

Colleen Norris graph

The blog post is light on specifics; however, the way options 1 through 3 are described indicates that the financial penalties in the QPP may be substantially lessened in the first year of program implementation.

CMS is scheduled to release the final rule by November 1. We will provide more details on this change, and what it means for the market at that time.

MACRA issues for providers to consider

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) presents several key issues for providers. In this article, Milliman’s Lynn Dong, Colleen Norris, and Christopher Kunkel examine the five considerations below related to MACRA and how they may affect providers. The authors also highlight details from the proposed regulation as well as potential implications for providers.

1. Under MACRA, the Medicare Part B fee schedule increases only slightly through 2019 and not at all from 2020 through 2025. After 2025, there will be minimal annual increases to the Part B fee schedule.

2. The Merit-Based Incentive Payment System (MIPS) consolidates and streamlines three existing programs, resulting in both negative and positive adjustments to providers’ current reimbursements.

3. MACRA encourages providers to participate in Alternative Payment Models.

4. Providers will need to make numerous decisions regarding the submission of quality metrics, participation in Clinical Practice Improvement Activities (CPIAs), and Advancing Care Information.

5. Participation in an Alternative Payment Model (APM) requires a careful review of potential financial risks and opportunities.

The article is part of a series examining the impacts of MACRA on providers, alternative payment models, and health plans. To read other articles in the series, click here.

How will providers be reimbursed under MACRA?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reforms how providers are reimbursed for care provided under Medicare Part B. In their article “MACRA: Overview for providers,” Milliman consultants Colleen Norris and Mary van der Heijde offer questions and answers concerning the three reimbursement adjustment options eligible clinicians will have under MACRA.

The article is part of a series examining the impacts of MACRA on providers, alternative payment models, and health plans. To read other articles in the series, click here.

MACRA considerations for health plans

In the article “MACRA: Key considerations for health plans,” Milliman consultants Colleen Norris and Mary van der Heijde answer four questions health insurers need to consider about how the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will affect their business:

• How does MACRA affect providers?
• Why is Qualifying Participant status so desirable, yet so challenging to achieve?
• What opportunities might MACRA provide for a health plan?
• For a health plan, what are the challenges associated with MACRA?

The article is part of a series examining the impacts of MACRA on providers, alternative payment models, and health plans. To read other articles in the series, click here.

How can risk adjusters improve the accuracy of value-based payment?

Providers should understand the health insurance risk they assume through value-based payment contracts, and how this might impact their reimbursements. Risk adjustment tools like the Milliman Advanced Risk Adjusters™ (MARA™) suite identify and isolate morbidity risk factors that are beyond a provider’s control. This may result in payments that more accurately reflect a patient population’s controllable risk. In this article, Milliman’s Colleen Norris and Stoddard Davenport demonstrate how risk adjustment can minimize the financial exposure associated with the morbidity risk that providers cannot influence.