Decoding Legalese of Value-Based Contracts

A Conversation with Hal Katz

Episode Overview
As the health care industry shifts from fee-for-service to value-based arrangements, providers are facing a lot of challenges. A provider’s relationship with payers is often strained by the new business model, and a provider’s ability to collaborate with payers has never been more important.

On this episode of Value-Based Care Insights, host Daniel J. Marino and Hal Katz, an industry leader in health care law, discuss how providers can successfully navigate value-based contracting with payers in a mutually beneficial way.

Key takeaways:

  • Previously there has been a lack of relationship between providers and payers; and with the shift towards value-based care, it is vital for those relationships to improve
  • Risk sharing requires the provider to agree to be responsible for a specific set of services and the costs associated with such services, which can include hitting certain performance measures. The elements need to be entered into the agreement otherwise there’s no obligation for the payer to honor those terms.
  • With all risk-based contracts, it key for providers to include protections. Such as, for example, that the financial arrangement doesn’t kick in until a minimum number of members assigned to the provider has been reached. Also, if there is a change in that threshold for two consecutive months, the payment bumps back down to the traditional fee-for-service rate.

About The Show
From Healthcare NOW RadioValue-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasing value-based care payment environment. Hosted by Dan Marino (@DjmarinoHD), the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners (@LuminaHP). Join the conversation on Twitter at #VBCInsights. This article was originally published on the Lumina Health Partners blog and is republished here with permission. For transcript, see original post.