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Areas of Expertise

Provider Payment Policy

Acumen is an industry leader in policy related to care delivery models and supports the Centers for Medicare & Medicaid Services (CMS) in all aspects of their reform, including their development, implementation, monitoring, auditing, and evaluation. As part of recent national initiatives to shift to care delivery that incentivizes quality and efficiency over quantity and complexity of services provided, our clients are testing a variety of incentive-based models that hold providers financially accountable for the quality and cost outcomes of their patients.

Acumen’s researchers have sustained a long and distinguished series of projects to support the development, implementation, and maintenance of the Centers for Medicare & Medicaid Services (CMS) payment systems in virtually all settings of care.

Acumen’s teams of analysts, statisticians, and clinicians support the Centers for Medicare & Medicaid Services (CMS) and other clients in the development of metrics for quality reporting and value-based purchasing (VBP) programs. These programs incentivize cost-effective care in hospital, clinician, and post-acute care settings by measuring provider performance.

Program Integrity, Safety, and Emergency Response

Acumen has cultivated significant expertise in supporting emergency preparedness and response efforts by public health authorities (PHAs) and investigating the effects of emergency situations on vulnerable populations. In our ongoing work with the Assistant Secretary for Preparedness and Response (ASPR), our group supports PHAs with targeted efforts when preparing for and responding to emergency situations, including rapid dissemination of customized datasets to identify at-risk individuals and populations. Our group also works to enhance ASPR’s understanding of the needs and circumstances of vulnerable populations who are at risk during emergency situations.

Acumen works with federal agencies to monitor the safety and efficacy of prescription drugs, medical procedures, vaccines, and other biological products. Leveraging our access to numerous national health care databases and statistical and epidemiological expertise, Acumen‘s research harnesses the rich information available in claims and administrative data to evaluate the impact of these products on the health and safety of Medicare, Medicaid, and commercially insured patients.

Acumen advises federal entities in safeguarding health care programs from fraud, waste, and abuse. We apply our deep knowledge in federal health care policy and data to uncover fraudulent behavior in Medicare and Medicaid. By using statistical approaches to reveal abnormal scenarios in live claims and provider enrollment data, we give stakeholders the evidence needed to develop policies that protect beneficiaries from unscrupulous practices.

Public and Private Insurance Programs

Our expert teams – comprised of economists, statistical programmers, clinicians, and public health specialists – offer data-driven answers to complex policy questions related to the Medicaid program, with a special focus on enrollees dually eligible for Medicare and Medicaid, who account for a disproportionate share of spending under both programs.

Providing high-quality analytic research in support of the Medicare program is a major pillar of Acumen’s work. Drawing upon our robust data holdings; clinical and technical expertise; and unparalleled institutional knowledge developed over decades of industry experience, our group works on projects at the cutting edge of health care policy development and implementation.

Through work with federal and state governments, Acumen has gained expertise in modeling and analyzing policies impacting both individual and small group insurance markets, including policies related to the Patient Protection and Affordable Care Act (ACA). Acumen’s work focuses on producing analyses to provide actuarial value calculations, identify discriminatory benefit designs, and support federal government rulemaking for the ACA health exchanges.