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Mistakes to avoid in risk sharing
Private payers have the most experience with managing risk, but each stakeholder must achieve a perfect balance of risk and reward.
While payers traditionally have relied on a fee-for-service approach to reimbursement, today's healthcare landscape increasingly allows payers and providers to enter into agreements that include shared risk. Private payers have the most experience with managing risk, but each stakeholder must achieve a perfect balance of risk and reward.
The Bundled Payment for Care Improvement Initiative is another way CMS hopes to improve the financing of care. Certain services lend themselves to a bundled model, in which providers operate within a budget to deliver a package of services related to one episode of care, such as knee replacement surgery and rehabilitation, for example. Many hope to advance care effectiveness and efficiency now before the market is flooded with new enrollees in the coming years.
Such risk-management agreements don't come without potential pitfalls for payers and providers. What's more, few provider organizations have previous experience, and best practices are still emerging. Healthcare experts believe that before any group enters into risk sharing agreements, the parties involved need to carefully consider what's at stake and determine in advance how potential problems can be prevented.
Upended: Can PBM Transparency Succeed?
March 6th 2024Simmering tensions in the pharmacy benefit management (PBM) industry have turned into fault lines. The PBMs challenging the "big three" have formed a trade association. Purchaser coalitions want change. The head of the industry's trade group says inherent marketplace friction has spilled over into political friction.
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In this episode of the "Meet the Board" podcast series, Briana Contreras, Managed Healthcare Executive editor, speaks with Ateev Mehrotra, a member of the MHE editorial advisory board and a professor of healthcare policy and medicine at Harvard Medical School. Mehtrotra is also a hospitalist at the Beth Israel Deaconess Medical Center in Boston. In the discussion, Contreras gets to know Mehrotra more on a personal level and picks his brain on some of his research interests including telehealth, alternative payment models and price transparency.
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Doing More and Saving More with Primary in Home Care
September 1st 2021In this week’s episode of Tuning In to the C-Suite podcast, MHE Associate Editor Briana Contreras interviewed VillageMD’s Senior Medical Director of Village Medical at Home, Dr. Tom Cornwell. Dr. Cornwell discussed the main benefits of primary care at home, which includes the benefit of cost savings for patients, maintaining control of hospital readmissions and others. Dr. Cornwell also noted what has changed in the industry of at-home care and if there has been interest from payers like insurance companies and medicare in the service.
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