The foundation of the ACO model, similar to an HMO, is provider accountability for care coordination; providers are incentivized via reimbursement based on their ability both to reduce costs through achieving efficiencies and to meet certain quality metrics. However, ACOs do not utilize a primary care gatekeeper and members are able to seek care from any provider they choose. Therefore, in order to measure a provider's performance, members must be attributed, or assigned, to a provider through an analysis of healthcare claims.
This session examines the issues surrounding patient attribution for Accountable Care Organizations, starting with relevant components driving patient attribution, and then focusing on the considerations involved in selecting and developing a specific attribution method.

The discussion will address elements including: patient-based vs. element-based attribution; single attribution vs. multiple attribution; prospective vs. retrospective attribution; hybrid multiple methods; and development considerations including duration, credibility, family unit vs. member, and members with no claims history.

Please join Susan E. Pantely, FSA, MAAA, Principal and Consulting Actuary with Milliman, Inc. on Wednesday, May 11, 2011, as she provides expert guidance for organizations that must grapple with this critical issue in developing, or doing business with ACOs.