Employers of all sizes are clamoring for prospectively paid episodes of care. Many providers are eager to enter into these programs with employers, and many payers make the claim that they can fully support prospectively priced and paid episodes of care. In actuality, though, they struggle mightily to do this at any scale. However, there are solutions, some of them are turnkey and give employers and providers what they need.
Topics for Discussion:
- What is an episode-based-prospective payment model and how does it differ from other models?
- What are the different flavors of a prospective payment model?
- Carve out
- Integration with employer TPA or health plan
- Payment distribution
- What benefits do prospective payment models provide to the major stakeholders?
- Payer (employer and health plan)
- What are the challenges to implementation with prospective payment models?
- Risk adjustments post payment reconciliation
- Contracting with downstream providers and ensuring distribution
- What is the current market adoption of prospective payment models?
Lisa Schulte, Senior Vice President, Commercial Business Lines, Remedy Partners