Managing Catastrophic Health Care Claims in the Post-Reform Era

Analytics can help providers to better quantify the costs and evaluate risk management solutions.

It now appears that an industry-wide shift to risk-based contracting is inevitable. As of 2013, more than one-third (35%) of health care providers had entered into a capitated or shared savings contract, compared to just 14% in 2011.

While the provisions of the Affordable Care Act (ACA) roll out through 2017, many health care providers are moving from fee-for-service revenue models to compensation that is based on quality outcomes. Entering into such risk-based contracts for Medicare, Medicaid, and commercial patient populations may expose these organizations to dramatically higher financial losses in the event of patients with catastrophic accidents or illnesses.

C-suite executives and other senior leaders are concerned about the potential bottom-line impact of these losses. In "Managing Catastrophic Health Care Claims in a Post-Reform Era," we review the new payment scenarios, the potential for higher potential losses, and strategies to employ to limit the exposure.