Epstein Becker Green (“EBG”) has released Value-Based Payments: A Comprehensive State Survey.
EBG has researched, compiled, and analyzed state-specific content about the regulatory requirements involved in providers moving away from fee for service reimbursement (such as discounted fees and per diems) and towards value-based payment arrangements involving “downside” risk or insurance risk-sharing with insurers, HMOs, and other types of state-regulated health plans. Some types of risk-sharing arrangements include capitation, shared savings and losses, and percentage of premium reimbursement.
Each state regulates insurance risk-sharing arrangements differently—some regulate only prepaid compensation models, some regulate all forms of risk, and some also regulate intermediary network entities which assume risk on behalf of networks.
Featuring contributions from attorneys Jackie Selby, Gregory R. Mitchell, and Ashley A. Creech, this survey is EBG’s most comprehensive compilation of state laws, regulations, and policies with respect to risk-sharing types of value-based payment arrangements.