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Value-Based Risk Solutions

Relationship Structure and Design

You know health care. But health plans might be new territory. Navigating the world of insurance can be tricky – and that’s where we come in. We’ll help you manage risk for your patient populations and share in the resulting savings. Every health system is different, which is why we aren’t a one-size-fits-all solution. Whether you're interested in value-based contracts or provider-owned health plans, we’ll work with you to help you achieve your specific goals and better serve your patients.

Accountable care unites everyone toward a common goal. As payers and providers combine strengths, there is amazing potential to radically transform care delivery.

- Christopher Lloyd, Chief Executive Officer, Memorial Hermann ACO

Assume Risk with the Right Resources and Expertise

Drawing on decades of insurance industry experience, we’ll help you assume risk based on your goals and market opportunity. We support a full range of value-based arrangements, including value-based contracts, co-branded health plans and provider-owned health plans. Once you choose your relationship structure, our team works with you on benefit and network design, as well as pricing and efficiency models.

Payment Models

Payment model options are flexible and include:

Value-Based Contracts based on your desired level of risk and point in your transition to value-based care. Examples include Pay-for-Performance, Bundled Payments and Patient Centered Medical Homes

Co-Branded Health Plans with attribution models that can include both employee and Medicare collaborations, as well as co-branded health plan products

Provider-Owned Joint Ventures, which result in a provider-owned health plan

Benefit and Network Design

We'll help you design the right products for your market, including:

Concentric Benefit Designs that are centered around your network and provide limited out-of-network benefits for members. These drive the strongest steerage to your organization. 

Tiered Benefit Designs that provide two or three benefit tiers with the lowest in-network patient costs

Dual Choice Offerings that offer both the concentric and tiered options alongside Aetna's broad network

Pricing and Efficiency Models

We provide support through our insurance expertise, helping you deliver:

Pricing models that fit your market and support competitive differentiation

Efficiency models that streamline operations, optimize utilization and identify opportunities for shared savings

Analytics that can help find leakage patterns across your organization and drive new strategies for patient retention

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