Nuts and Bolts of Payer-Provider Contracts Webinar


Session Handout

Nuts and Bolts of Payer-Provider Contracts June 14, 2023 11:30 AM - 12:45 PM

The contents of a payer-provider contract determine reimbursement levels being paid by payers to providers. What are the primary variables included in these contracts that impact actuaries’ work, both volume-based and value-based? How does this vary for commercial insurance companies vs government programs? In this CCA healthcare series webinar, presenters discuss these questions and more.

  • Understanding the basics of fee for service (FFS) to help set the stage for value based contracts (VBC)
  • Types of quality metrics in VBC contracts, financial terms, and operational issues related to tracking, monitoring and accruing
  • Evolution of shared savings from FFS to full risk
  • Contractual components of VBC contracts from a provider's perspective

Session Category: Health & Welfare
Credits: CPD: 1.50
  • 1 . Joseph Dean Heintzelman Optum
  • 2 . Daniel Patrick Santmyer Cedar Gate Technologies
  • 3 . Zach Davis Health Actuary
  • 4 . Caleigh Bart VillageMD