Ashworth College At Risk Contracting Discussion

Ashworth College At Risk Contracting Discussion

Activity 2: At-Risk Contracting (100 points)

Respond to the prompts below in no more than two pages. Separate and identify your responses to Parts A, B, C, D, and E.




You are a practice manager for Accelerated Health (AH), a  25-physician hospitalist group that practices at St. James Hospital, a  large hospital in an urban area. The hospital currently contracts with  five hospitalist groups, but AH manages the largest share of the  hospital’s 1,500 monthly patient cases. AH has performed better than the  other hospitalist groups in some of the hospital’s key performance indicators, such as average length of stay (LOS). Currently, AH operates  entirely on a fee-for-service model with no risk-based contracts. Their  payer mix is 50% Medicare or Medicaid, 46% private insurance, and 4%  self-pay. Referrals from primary care providers and other specialists  drive most of their patient volume, and they continue to remain  competitive in managing patient volumes at St. James. AH is only one of  two hospitalist groups that covers the emergency department and also  manages patients at a long-term acute care hospital. Managed care and  capitation payments have yet to be widely adopted in your market, but  there may be an opportunity for AH to be a first mover considering their  payer mix and the patients they serve. Ashworth College At Risk Contracting Discussion

You’re approached by OptiHealth, an insurance payer, to manage their  dual-eligible patients admitted to St. James under a capitated arrangement. Most of these patients have multiple comorbidities and  require more intensive care, but OptiHealth has a history of  transferring its patients from other local hospitals to St. James  Hospital. The initial contract would include a $600 payment per patient  admission for an anticipated 20 patients per month. It would also  require AH physicians to frequently meet with OptiHealth case managers  to ensure care is appropriately coordinated. All 25 of your hospitalists  need to be in agreement before taking on any form of a risk-based  contract.

Identify what you perceive to be the key facts of the case. (20 points)

Identify and describe key stakeholders or areas needing consideration. (20 points)

Describe some reasons why you might recommend accepting the contract. (20 points)

Describe some reasons why you might recommend rejecting the contract. (20 points)

Identify your recommendation and explain why.  Ashworth College At Risk Contracting Discussion