This background paper, produced for CCI by Pacific Health Consulting Group in collaboration with Andrew Naugle and Susan Philip of Milliman, Inc., hopes to spur discussion of payment models and shared savings programs.
Since the passage of the Affordable Care Act, many states, plans and providers have been considering or even experimenting with new payment models designed to incentivize care that improves patient health and saves the entire health system money. These plans seek to calculate and share those overall savings with providers and organizations delivering good primary and preventative care. The trade off is that providers take on a certain level of risk for managing the health of their patients at a set cost per member, instead of billing for each service rendered.
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