As federal health reform legislation has stalled, health policy attention turns to the states, which have many tools to reform their health care systems. While 1115 waivers rightly get a lot of attention, because of their ability to reshape state Medicaid programs, the Affordable Care Act’s Section 1332 waivers continue to be a promising avenue for states.
Safeguarding Financial Stability of Provider Risk-Bearing Organizations
Erin Taylor and Michael Bailit, Bailit Health
JoAnn Volk, Georgetown University Health Policy Institute
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.