As Insurers Balk on Risk Sharing, Providers Take Charge

Philip Betbeze, August 16, 2013

Many hospitals and health systems aren't waiting for insurers to implement risk sharing into their contracts. Instead, providers are experimenting on their own—especially those that already own health plans.

As the third annual HealthLeaders Media CFO Exchange in Colorado Springs winds down to a close, I am struck by the wide variety of experience around the country surrounding population health initiatives and risk sharing for hospitals and health systems.

Before I go on, there's nearly universal agreement that healthcare takes up too much of the nation's GDP, and that outside of rationing care, which is unlikely to happen even in the long-term, risk sharing is likely the best way to reduce cost growth.  

By risk sharing, I mean that at least part of hospital and physician payment is "at risk" based on how well providers meet certain targets on processes, overutilization, readmissions and other metrics.

In some geographical areas, health plans are being innovative. But in most areas, they don't seem to be, not on a broad scale, that is. Instead, with the consent of employers, payers are content to offload risk onto patients through high deductible health plans.

Philip Betbeze

Philip Betbeze is the senior leadership editor at HealthLeaders Media.

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