Contracting for Outcomes
Care providers keep us healthy, treat us when we're ill, and guide us through life's most challenging moments. It is that sense of purpose that motivated countless doctors, nurses, specialists, physician assistants, physical therapists, and other care providers to seek out medical training in the first place. We all benefit from their professional expertise on a day-to-day basis and through the most trying times, such as the COVID-19 pandemic.
Connecting for health through our digital platform that curates and links services for complex care management, home-based care, palliative care, pharmacy, social needs, and other resources when needed.
Types of Payment Models
Upside — Care providers keep a portion of any savings they create with the payer sharing a portion of the overall savings. If a care provider doesn't create savings and has a loss, they do not owe anything to the payer.
Partial downside — Care providers keep a portion of any savings they create with the payer sharing a portion of the overall savings. If a care provider doesn't create savings, they owe a portion of any losses incurred to the payer.
Full risk/capitation — Care providers receive an agreed-upon, per-patient-per-month payment for a specific set of services, such as preventive or diagnostic care, and take on full risk of managing that patient population. If costs are less than the payments, the care provider retains savings; if costs are greater than the payment, the care provider is responsible for absorbing that.
In all of these models, payment depends on meeting or exceeding quality, outcome, experience, and other benchmarks.
Bar chart comparing provider payment models by degree of risk-sharing against potential for improved efficiency and quality, ranging from fee for service, upside shared savings, partial downside, and full risk capitation
We are committed to value-based care as a critically important means for improving healthcare in America. In addition to continued investment in primary care models, we are also broadening our approach through strategies such as expanding our value-based care programs to partner with specialists in all business segments and evolving our ability to collaborate more deeply with high-performing care providers who prioritize health equity and consumer experience. Most importantly, we are committed to being active partners who go beyond the contract, delivering on the promise of value-based care and creating a real impact for patients — our consumers — while helping care providers thrive.