What should payers and providers understand about joint venture health plans?

Joint venture health plans are still relatively new to providers and payers. It’s important for both sides to engage a skilled actuary who can assess the potential risks and benefits of such a partnership. In this article, Milliman actuary Lynn Dong provides some perspective on the following questions that providers and payers must consider concerning joint venture arrangements.

• How much is the provider system’s volume likely to increase?
• What is the provider’s range of potential outcomes under the rate concession or risk-sharing arrangement? How does this compare with the current contractual reimbursement arrangements?
• What insurance risks are transferred from the payer to the provider, and how will these risks be managed?
• How will the responsibility for care management, ongoing data and financial reporting, and financial settlements be allocated? What additional resources will be needed from the provider and payer to perform these functions?
• What ongoing data and reports will be made available to the provider? What level of detail will be available, and how often will this information be provided?
• What are the key financial, strategic, and business risks for the provider and payer?

2 thoughts on “What should payers and providers understand about joint venture health plans?

  1. Not a trivial list indeed! Each of these is a major consideration. I suggest paying extra consideration to addressing “responsibility for care management, ongoing data and financial reporting, and financial settlements.”

    Data collection, coding, exchange and management can be a hugely expensive endeavor and, if not done correctly and on a timely basis, will render the best of outcomes on all the other items useless.

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