ACO Reinsurance

U.S. Advisors has developed a new Reinsurance Program in response to the final regulations published recently by CMS for the Medicare/Medicaid ACOs At Risk Program. The program is a response to physicians' need to eliminate downside risk under the new ACO Regs for Track 2 programs and allows them to capitalize on the increased profits potential vs. Track 1.

“We recognize the unique requirements of organizations that want to participate in the ACO Shared Savings Program and their need to moderate their downside risk in an affordable fashion,” notes Terry Chesser, U.S. Advisors' Principal. “We have been tracking this issue from the draft regulations and our team has been working on the development of this new program for a number of months.”

The ACO Reinsurance Program recognizes the delayed cash flow compared to traditional health care financing mechanisms, as well as other unique aspects of the Shared Savings/At Risk Program. It is designed to protect an ACO's capital as they take risk on Medicare and/or Medicaid members.

• Eliminates pressure from the downside risk and the cash flow requirements of the ACO
• Significant Additional Profits of Track 2 (with Reinsurance) vs. Track 1 (without reinsurance/no risk)
• Rates Competitive and Consistent with Integrated Clinical Model of ACO
• Risk Model Tailored to CMS Regs, i.e., payment schedule to Docs, true up provision, funding trigger points, etc.
• $20,000,000 Capacity Limit
• Minimum Coinsurance Participation of 10%
• Due Diligence required for those ACOs in order to Qualify for participation in the Program
• Placement by International Reinsurer

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