What amount of shared savings will you have to pay back to the insurer due to your downside risk? What is the shared savings amount your organization can expect?.
Referring to the Module 4 Supplemental PowerPoint (slide 24), respond to the following:
You are the director responsible for the success of your health system’s commercial ACO contracts. You’ve done a great job with quality so your focus turns to your shared savings.
You need to report back to your leadership on your two largest ACO arrangements. The financials are as follows:
Arrangement #1:
Total Attributed Population: 30,000 patients
Agreed Upon Budget: $165 Million
Percentage of Risk: 30% upside and 10% downside
Results:
Medical PMPM: $310
Pharmacy PMPM: $112
What is the shared savings amount your organization can expect?
Arrangement #2
Total Attributed Population: 45,000
Agreed Upon Budget: $230 Million
Percentage of Risk: 35% upside, 12% downside
Results:
Medical PMPM: $350
Pharmacy PMPM: $115
What amount of shared savings will you have to pay back to the insurer due to your downside risk?
Submit your response in a Word document. Include your calculations for each arrangement and explain your logic for each step.
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