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Deep dive: 5 partnership models in commercial risk

Payer-provider partnerships will play a significant role in the future of value-based care (VBC). This is especially true for commercial risk, where there is no central body (like CMS) charting the course for clinical and payment models. Without a prescribed roadmap, payers and providers working in the commercial space have a great deal of flexibility to work together on their value-based care goals.

Most payer-provider partnerships focus on building population health infrastructure, improving care coordination efforts, overcoming data challenges, and growing the number of commercial lives under risk. But with so many ways to partner, and no clear definition of what constitutes a true partnership, leaders working toward commercial risk may find themselves at a loss for how to work together—and exactly who to work with.

Read on to learn about five payer-provider partnership models being applied to commercial populations and why they may be the right or wrong path for your organization. Each model comes with its own business goals, benefits, and trade-offs.

Compare each model quickly with our accompanying comparison chart, linked here.

  • Model 1: Custom risk-based contract
  • Model 2: Payer-branded value program
  • Model 3: Third party-mediated relationship
  • Model 4: Risk-bearing network collaboration
  • Model 5: Joint venture insurance product

Parting thoughts

There are many ways for payers and providers to partner, but partnerships take a lot of time and resources. So, prioritize commercial risk models that work best for your organization’s goals and specific market. And remember that partnership is more than just designing a contract; it involves changing the culture within organizations to turn a historically antagonistic relationship into a collaborative one.

For help navigating change management within value-based care partnerships, review our blog series (Part 1 and Part 2) for lessons learned from Advisory Board experts.

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