Preparing For The Health Plan Shift

For most specialty and primary care provider organizations, contracts with health plans are a strategic necessity. Health plan enrollment has grown across the commercial, Medicare, and Medicaid sectors. They control the majority of provider reimbursement for health care services—and their reach in long-term care, I/DD, foster care, and social services has extended with that expanded footprint.

But that is not the end of the strategy story. Almost 19% of health plan reimbursement to provider organizations is now in contractual arrangements with downside financial risk—with only 40% of reimbursement in traditional fee-for-service contracts with no . . .