New payment models link health plan and provider organization reimbursement to value by incorporating cost, consumer health outcomes, and consumer experience into the payment equation. While this shift poses many obstacles in financing and operations for provider organizations, it also creates new challenges for clinical treatment models. In this discussion session, we’ll review how capitated contracting impacts clinical care, the ethical issues that accompany a move to capitation, and how clinicians can balance the needs of their consumers with the needs of their organization’s financing arrangements. We will also hear how organizations are utilizing innovative carve-outs to control costs in narrow networks and partnerships. After attending this session, you will be able to:
- Identify areas within your organization that could benefit from creative problem solving
- Utilize capitation, carve-outs, and contracts to better position your organization for market success
- Adopt strategies to take back to your organization to positively affect your bottom line