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The healthcare landscape is rapidly changing, and providers are taking on more risk. Numerous marketplace changes and regulatory changes are taking effect, and providers need to be ready to understand and react to those changes.
It’s more important than ever for providers to see the financial implications of these many changes. Milliman can perform financial feasibility projections so that providers can better understand the marketplace and respond accordingly. Even after entering into your contracts, Milliman can perform ongoing financial projections to assist in financial reporting and to get an early indication of potential performance issues so that they can be addressed through contract renegotiation or improved clinical performance.
The Medicare Access and CHIP Reauthorization Act (MACRA), for example, is changing how providers are paid. These changes are not across the board and depend on many variables, like value-based contracts, quality measures, and number of attributed patients Within MACRA, there are various payment tracks available and we can help you understand which track is most advantageous, in part by performing financial feasibility projections. Milliman can model providers’ data and experience and benchmark it to determine how their measures compare to the market so that comparisons are clear and understandable, providing information to act on. We also do scenario testing, determining best estimates on costs and how variable those costs can be.
Even for those providers that still receive the majority of their payments under traditional fee-for-service environments, it’s important to understand how changes to those structures will affect financial performance. Significant changes are being made to Medicare’s fee-for-service payments, which will affect not only direct reimbursement from Medicare, but also the increasing number of fee-for-service contracts that are based upon Medicare schedules. Milliman can help you stay updated on those changes and model the impacts on your population and revenue.