201409.29
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Health Care Risk Sharing, Integration & Accountable Care – Part 12

RISK SHARING, INTEGRTION AND ACCOUNTABLE CARE—BASIC PROVIDER CONTRACTING CONSIDERATIONS Contractual Terms of Note and Basic Principles:  Provider-counsel should pay particular attention to the following issues, and the associated contractual terms: Scope of Services Required, Capitated Payments, Withholding Pools and Agency/Sub-Contracting: The scope of services offered by provider should be adequately defined.  Furthermore, protocol for the…

201409.22
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Health Care Risk Sharing, Integration & Accountable Care – Part 11

RISK SHARING, INTEGRATION AND ACCOUNTABLE CARE—BASIC CONTRACTING CONSIDERATIONS FOR PROVIDERS Basic Extra-Contracting and Pre-Contracting Considerations: Providers must review the MCO, the network plan and/or the contractual clauses or venture terms underlying same, for answers to the following questions: (a) What are enrollment and disenrollment through the MCO, (b) what other providers are under arrangement with…

201409.15
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Health Care Risk Sharing, Integration & Accountable Care – Part 10

RISK SHARING, INTEGRATION AND ACCOUNTABLE CARE: MECHANISMS FOR PROVIDER RISK SHARING AND INTEGRATION Hospital Risk Sharing:  Generally, hospital payments take a form similar to physician risk sharing forms, re-branded in the hospital context, or are a hybrid of these traditional risk sharing forms with novel elements. Capitation and Withhold Pools: Capitated payments at a basic…

201409.08
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Health Care Risk Sharing, Integration & Accountable Care – Part 9

RISK SHARING, INTEGRATION AND ACCOUNTABLE CARE:  MECHANISMS FOR PROVIDER RISK SHARING AND INTEGRATION—Traditional and Modern Twist to Risk Sharing Through Provider Compensation Arrangements Regarding risk sharing, physicians are generally subjected to capitation and withhold pools: Discounted Fee For Services: Fee for service is a non-risk sharing, traditional reimbursement arrangement for providers. A flat discount off…

201409.01
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Health Care Risk Sharing, Integration & Accountable Care – Part 8

RISK SHARING, INTEGRATION AND ACCOUNTABLE CARE: MECHANISMS FOR PROVIDER RISK SHARING AND INTEGRATION Risk sharing and positioning a continuum for negotiation may also benefit from by creating a specialty and carve-out network.  Although a provider network’s market position generally benefits from offering a complete continuum of care, limited provider networks that target certain market niches…