VBC Payor Contracting
Assist health services organizations (specialties and primary care) with improving their Value Based Care (VBC) arrangements with payors.
Services We Provide
We provide the following five products for VBC payor contracting
For Specialty Practices
Review existing VBC contracts (often capitated deals with MA plans) to understand effective reimbursement rates and compare to market benchmarks. Can advise on how to proceed and manage negotiation process with payors and/or RBE organizations which patients the specialty practice is serving.
Explore new VBC contracts. Since many specialty practices often have significant patient volume attached to Risk Bearing Entities (‘RBEs”). These are risk taking MSOs or primary care organizations, ACOs and/or payors with populations which they share risk on (MA and ACA). We can review these volume trends and quantify the cost and quality of services provided to determine if a VBC economic relationship (shared savings, quality bonuses, per patient cap arrangements) would be beneficial between the practice and the RBE/payor.
For Primary Care Practices
Review existing VBC contracts with payors, MSOs and ACOs to determine PCP caps, shared savings arrangements and nuances of the economic arrangements (percent of premium funded, quality incentives, and savings distribution calculations.) in order to benchmark against the market. Can advise on how to proceed and manage negotiation process with payors, MSOs and ACOs which the practice has membership under.
Where taking global risk, can review nuances of the risk arrangement, from percent of premium funded, to Part D arrangements, stop loss charges, imbedded payor costs (member benefits or unnecessary capitations passed to the primary care organization’s service fund) benchmark against the market. We can advise on how to proceed and manage negotiation process with payors, MSOs and ACOs which the practice has membership under.​
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