Following guidance released earlier this fall, on November 29, 2018 the Centers for Medicare & Medicaid Services (CMS) released a discussion paper entitled “Section 1332 State Relief and Empowerment Waiver Concepts” to provide states with additional guidance and information about four types of waiver concepts that could be approved under the earlier guidance. This expert perspective reviews the four waiver concepts proposed in the discussion paper and the potential opportunities they present for states.
Safeguarding Financial Stability of Provider Risk-Bearing Organizations
Erin Taylor and Michael Bailit, Bailit Health
JoAnn Volk, Georgetown University Center on Health Insurance Reforms
An increasingly common feature of health care payment models is the transfer of financial risk from payers to providers for health care services delivered to a defined population of patients. In these “value-based payment” models, providers accept financial responsibility (i.e., liability for financial losses) should spending for most, or all, services for an attributed patient population exceed targeted levels. This financial liability is often shared with payers, and maximum risk exposure is typically capped. This issue brief explores options for states as they consider oversight of risk-bearing organizations , with a focus on states that have elected to act to protect against provider insolvency.
The State Health Policy Highlight, Risk-Bearing Organizations Oversight: State Considerations, reviews specific state considerations when overseeing risk-bearing organizations. An accompaniment to the issue brief, Case Studies: State Examples of Safeguarding Financial Stability of Provider Risk-Bearing Organizations, provides a deeper dive into approaches in four states: California, Massachusetts, New York and Texas.
State Health and Value Strategies hosted a companion webinar, Safeguarding Financial Stability of Provider Risk-Bearing Organizations, based on the issue brief that provided an overview of options for states as they consider oversight of risk-bearing organizations (RBOs) as well as a deeper dive on the Massachusetts approach.