Accountable Care Organizations & the Fraud Impact
(Room Seaport A)
18 Nov 15
2:15 PM
-
3:15 PM
Tracks:
Management Path, Transformation of Health Care
The presenter will provide a legal overview of Accountable Care Organizations (ACOs), to include a review of what they are, the objectives, how they operate, and how this type of care is changing or blurring the lines between payer and provider. In addition, the presenter will discuss some of the quality metrics, and how fraud risk associated with those submissions will need to be evaluated. Finally, the presenter will discuss the relationship between the shared savings methodology, and the NHCAA ROI Standards. He will explore more closely how the long held beliefs about prevented loss will need to be re-examined as provider performance will be measured by trending actual versus expected performance.