In some cases, these care management costs may be subject to the minimum quality thresholds mentioned above, but in many cases only common savings are affected. These fees can also be guaranteed or depend on a service provider organization to generate savings depending on the specific agreement. If a deal. B includes an agreement of $5 per member per month, which depends on the savings, a provider organization may be required to generate at least $5 in savings to obtain the full cost of managing care. A brief history of entering into a risk-based contract, also known as value-based reimbursement, or VBR, has existed for many years in one form or another, as a method for payers to transfer some of the responsibility for cost and quality control to suppliers. VBR became known in the 1990s in the United States with EROs, but it was disgraced by consumer reaction. In recent times, risk-based public procurement has been reinstated. One of the most common types of VBR contracts is common savings contracts. Another method of adjusting PMPM care costs uses a trend based on a retrospective industry average or an independent third-party trend. This method assumes that the third-party trend represents the trends of the provider organization without the common savings agreement. One of the advantages of using third-party trends is the objectivity of the trend, although there may be questions about the adequacy of sector averages for a given supplier organization.
The success of a value-based reimbursement agreement often depends on the due diligence implemented by the provider organization before signing a common savings contract, as well as the efforts of the provider organization to reduce costs and improve the quality of care they provide. There are a number of ways to determine whether a supplier organization is successful before entering into a risk-based agreement. One of the drawbacks of the loss rate is that the inclusion of the premium in the objective can result in additional risks to the supplier. Member-specific bonus rates, particularly those developed under EU rating rules, may be considered insufficient in relation to the member`s proposed rights. The ACA, for example, requires that premiums be set with an age rating curve of 3:1. These age factors, even when combined with risk adjustment transfers, cannot be sufficient to cover the projected claims and expenses of certain members whose projected fees fit into a 6:1 age curve. The chart below shows how this risk is magnified if the actual mix of members is older than expected when premium rates change. Learn about the possibilities of shared savings contracts in your supply chain. Renegotiate these contracts so that both parties agree on a unit price for materials that generates benefits for both parties. Many contract models exist and can be adapted to your situation: z.B. a flat fee for services, reimbursement of the volume of equipment used and distribution of potential efficiency gains.
Adjustments for a Fair Comparison Necessary A common savings contract is ideally used to measure the savings made by suppliers and not to reward random fluctuations or simple happiness.