Provider Risk Analysis, Contracting, and Operational Design

The Affordable Care Act introduced the ACO model to give health care organizations an incentive to use innovative mechanisms for coordinating care and integrating delivery. Many hospitals and health plans are already starting to develop and adapt to systems in which provider accountability, risk management, shared savings, and performance measurement are critical. But accountable care is a concept, not a model, and organizations will take different routes to achieve effectiveness.

Whether you’re looking to dip your toe in the water by implementing a bundling program or are ready to analyze taking on full risk, we bring decades of experience to help those looking to enhance or perhaps just sustain their organizational effectiveness. Our services include:

  • Strategic planning
  • Provider risk readiness assessments and performance enhancement
  • Operational design and implementation
  • Shared savings and bundled payment assessment and development
  • Licensure acquisition, such as California Knox-Keene licenses
  • Contract assessments and negotiation support
  • Hospital, medical group, and payer collaboration and integration
  • Incurred but not reported (IBNR) model development and reserve adequacy analytics
  • IT system assessments, design, and selection for payer, hospital, and group systems
  • MSO selection assistance and operational reviews
  • Physician and hospital revenue cycle management assessments
  • Provider network development and network sufficiency assessments

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Baker Tilly US, LLP, Baker Tilly Advisory Group, LP and Moss Adams LLP and their affiliated entities operate under an alternative practice structure in accordance with the AICPA Code of Professional Conduct and applicable laws, regulations and professional standards. Baker Tilly Advisory Group, LP and its subsidiaries, and Baker Tilly US, LLP and its affiliated entities, trading as Baker Tilly, are members of the global network of Baker Tilly International Ltd., the members of which are separate and independent legal entities. Baker Tilly US, LLP and Moss Adams LLP are licensed CPA firms that provide assurance services to their clients. Baker Tilly Advisory Group, LP and its subsidiary entities provide tax and consulting services to their clients and are not licensed CPA firms. ISO certification services offered through Moss Adams Certifications LLC. Investment advisory offered through either Moss Adams Wealth Advisors LLC or Baker Tilly Wealth Management, LLC.