Editor’s Note: We are excited to announce that this article is the first of a series addressing the intersection of payor/provider convergence and the issues that plague insurance and health companies, payors, and providers. We will be addressing various considerations including the end of the Public Health Emergency, CMS’ innovation models and trends, private equity in the risk bearing space, expansion of coverage for telehealth services and more.
Welcome to the Payor/Provider Convergence Series of the Health Care Law Today blog. This series is dedicated to exploring the intersection between payors and providers in the health care space; in particular, the evolving trend toward value based payment structures. Payors and providers in the health care space both want high quality and cost effective care delivered to their members and patients, and these two groups are finding new ways to achieve their mutual goals.
Health care providers are increasingly taking financial risk in their contracts with health insurance companies and, in turn, health insurance companies are becoming more involved in the delivery of care. As each group begins to take on certain characteristics and responsibilities of the other, it is important that they understand the scope of the laws and rules applicable to them.
For example, health care providers and health insurance companies may enter into payment structures where the insurers pay providers to manage a specific types of care for a group of...
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