Shared risk is the new norm

Amid lingering Affordable Care Act actions, one fact remains: Payers, providers and patients already are making the shift toward risk sharing, Healthcare Finance News reported.

In fact, about one-third of Americans will have a shared-risk plan by 2020, Andrew Croshaw, a partner with the healthcare intelligence firm of Leavitt Partners, said this week at the HFMA ANI 2014 conference in Las Veags.

Croshaw also said Congress will take steps to make providers bear more risk, noting that regardless of which party controls the Senate next year, the risk-sharing trend will continue to grow, the article noted.

So far, the most active experimenters in risk-bearing arrangements have been physician groups. But major payers also are embracing the shared risk approach, especially Cigna, Aetna, UnitedHealthcare, Anthem, and Blue Cross Blue Shield companies in Massachusetts, California and Michigan, Croshaw noted.

Payers need to get providers to take on risk in new payment models to improve quality and value throughout the healthcare system, FierceHealthPayer previously reported. One way to obtain buy-in is to start with early adopters. Insurers should begin by incorporating up-side risk only, and launch new reimbursement methods with doctors who are willing to try new things and see value in innovations. Insurers also need to be flexible when making the shift to shared risk and recognize there's no silver bullet that will please all providers within their networks.

Blue Cross Blue Shield of Massachusetts found success with its alternative quality contract (AQC), a shared-risk model that doesn't make providers hold all the risk. "When it comes to risks, our model is symmetrical--it shares in savings as well as shares in deficits,"  BCBSMA Senior Vice President of Performance Measurement and Improvement Dana Gelb Safran, told FierceHealthPayer in an interview earlier this month. "We build in protection for the provider so no excessive spending occurs. We engage the provider in the clinical risk and not the insurance risk," she said.

To learn more:
- read the Healthcare Finance News article