Health Plans & RBOs

Health plans and risk-bearing organizations (RBOs) face increasing pressure to effectively manage and administer complex, multifaceted risk pool agreements and respond to stakeholder requests for risk pool funding.

As the health care industry moves away from rewarding providers for volume and shifts to rewarding for value, organizations need to embrace this paradigm change and thoughtfully prepare for it. In the complicated managed care environment, the risk-based health care model continues to rise in popularity. The model has significantly evolved since its development more than 25 years ago, and many organizations engaged in risk contracting lack the industry-based expertise to support developments and effectively manage their membership.

Our professionals have roots in Southern California, the epicenter for managed care and RBOs since they first rose to prominence. Immersed in risk-based health care for decades, our professionals understand how to make smart business decisions and find innovative solutions that drive growth and strengthen your bottom line.

How We Help

We can assist your organization with:

Who We Serve

We work organizations of all sizes including:

  • Accountable care organizations (ACOs)
  • Coordinated care organizations (CCOs)
  • Dental plans
  • Exclusive provider organizations
  • Insurance exchanges
  • Independent practice associations (IPAs) and medical groups
  • Knox-Keene plans
  • Managed care and service organizations
  • Medicaid health plans and Medicare advantage plans

Pre-Election Political Point-Counterpoint with Donna Brazile and Newt Gingrich, Moderated by Susan Dentzer

Pre-Election Political Point-Counterpoint with Donna Brazile and Newt Gingrich, Moderated by Susan Dentzer

Oct. 29, 2020, 1:00 p.m.-2:20 p.m. PDT

Watch influential political strategists Donna Brazile and Newt Gingrich tackle some of the most pressing issues in politics and health care leading up to the 2020 election.


Deal Land: What’s Happening on the Landscape of Health Care Transactions

Deal Land: What’s Happening on the Landscape of Health Care Transactions

Sept. 16, 2020, 9:00 a.m.-10:20 a.m. PDT

Explore how COVID-19 impacted transactions and investments in the health care ecosystem, and what’s in store for 2021.


Vertical Integration and Value-Based Care: Will New Payer Alliances Transform Care?

Vertical Integration and Value-Based Care: Will New Payer Alliances Transform Care?

Sept. 24, 2020, 9:00 a.m.-10:20 a.m. PDT

Explore why vertical integration works, lessons learned from the COVID-19 pandemic, and more.


The Current and Future State of Medicare

The Current and Future State of Medicare

Oct. 8, 2020, 10 a.m.-11:20 a.m. PDT

Dive into the current and proposed states of Medicare reimbursement in 2020 and the coming year. This session will cover emerging issues and factors impacting rate setting and reimbursement caused by changes in hospital operations and economic disruption during the pandemic.


Innovations in Telehealth: How Telehealth Transformed Health Care Delivery and What the Future Holds

Innovations in Telehealth: How Telehealth Transformed Health Care Delivery and What the Future Holds

Oct. 20, 2020, 10:00 a.m.-11:20 a.m. PDT

The wide-spread adoption of telehealth has proved a rare upside to the pandemic. Learn about the present regulatory landscape of telehealth and reimbursement, and hear from innovators in the telehealth space.


2020 State of the Union: The Resilient Health Care System Presented by The Advisory Board

2020 State of the Union: The Resilient Health Care System Presented by The Advisory Board

Nov. 12, 2020, 1:00p.m.-2:20 p.m. PST

The Advisory Board’s Ford Koles addresses the significant opportunities and challenges facing the health care ecosystem following the 2020 election and the COVID-19 global pandemic.


Wrap-up Expert Panel Discussion: How Will the Health Care Revolution Play Out? Predictions for 2021

Wrap-up Expert Panel Discussion: How Will the Health Care Revolution Play Out? Predictions for 2021

Nov. 19, 2020, 10:00 a.m.-11:20 a.m. PST

Several notable experts return to conclude the series and explore key themes addressed during previous sessions, as well as reflect on where C-suites should focus attention in 2021.


Insights


Article
Learn how changes to the Medicare Shared Savings Program more easily allows health care organizations to transform to a value-based care organization.

Webcast
As CMS continues to promote alternative payment models and reward providers based on outcomes, value-based programs and reimbursement models are here to stay. This panel discusses success stories of providers and payers who have adopted value-based programs and are realizing success.

Article
A third-party administrator audit, sometimes called an administrative claims review, helps tribes create accountability, measure performance, and establish processes for quality improvements.

Article
Internal audits of risk-bearing contracts can help reduce a health care organization’s financial exposure.

Article
Learn how a benefit claims audit serves as a cost containment strategy to help ensure your company isn’t losing money to improperly paid claims.

Webcast
Join Moss Adams LLP and PPC Partner Plus Consulting, Inc. to learn how various claims audits can help achieve cost savings and performance goals for self-funded insurance plans.

National Practice Leader