​​​​​Achieving Accountable Care

Financial Reconciliation

As the scope of shared service models continues to expand, a corresponding expansion of the collaboration among participating entities will necessarily begin to include shared compliance targets and responsibilities, and assessment of competitive performance in a variety of heterogeneous micro-markets where the extended enterprise operates.

Organizations pursuing this stage are often seeking to answer key analytical questions​ such as:

  • Are we Reconciling our Charges, Payments & Costs with our Accountability Models?

The following Action Plans are concrete steps organizations must consider for progressively achieving this stage.

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Action Plans
​Retrospective Payments
  • Identify actual expenditures (payments) for measured populations, and align with contracted discounted fees for targeted services by parties

  • Compare aggregate and segmented expenditures against targeted fees; perform segment performance analysis

  • Forecast financial outcomes by population, segment and service areas

​Shared Savings & Costs; Allocated Gains (Losses)
  • ​Identify savings on actual expenditures (payments) by comparing aggregate and segmented expenditures against targeted fees

  • Identify costs and resources to deliver services, align with payments along all relevant dimensional attributes

  • Assess savings by population, segment, service area, and contract area

​Value Realization
  • ​Align service delivery events and resources with shared, coordinated value streams and collaboration terms; measure shared performance

  • ​Quantify value realization and reconcile financial events and outcomes to service delivery events, participants, resources and costs; assess shared value and allocate to contributors (events, resources, etc.)

Billing & Payment Distributions
  • ​Define models for aligning value and cost contribution with anticipated incentives and payments

  • ​​Examine factors for defining models (e.g., volumes, charge levels, quality measures, cost reduction, etc.)

  • ​​Apply models and reconcile actual outcomes with projected models

  • ​​Prepare payment, cost and/or penalty allocation based on results of reconciliation of models and actuals

​Compliance Targets & Adherence
  • Identify shared responsibilities for coordinated collaboration and corresponding performance criteria and measures

  • Establish shared compliance targets and responsibilities, time frames and accountabilities; monitor performance