Goals and Challenges to Making Commercial ACOs Successful – from Payor and Provider Prospective

Jennifer Leazzo, FSA, MAAA
William Olaprath, FSA, CERA, MAAA

PPACA outlined legislatively how the government would operate ACO and CMMI has authority to try new programs to achieve reduction in health care cost delivery for Medicare Beneficiaries.  Commercial carriers are trying to follow suite but have a unique set of challenges that the Medicare population does not have.  How can (and do) payors and providers work together to solve this dilemma?

William Olaprath will present the Payor side, and Jennifer Leazzo will present the Provider side.

Jennifer Leazzo spent 20+ years on the payor side spanning from Clinton’s proposed health care reform in 1993 through the implementation of the Affordable Care Act in 2014.    In 2014 she decided to take her actuarial expertise to help providers understand how to be successful under the ACO structure in the new legislation doing provider consulting for Optum.  In 2016 she joined Boncura to lead analytics used by DMG to be successful in all the various value based care contracts in which they are engaged.

William Olaprath is Sr. Managing Actuary, Provider Payment Innovation & Analytics, at Health Care Service Corporation (BCBS – IL, TX, OK, NM, MT).  He has 5 years of experience with measuring TX commercial ACO financial performance as well as experience with various commercial ACO measurement models. He has assisted with designing and implementing the current TX commercial ACO measurement model and presents and explains ACO financial measurement results to hospitals and physicians.

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