What you need to know about the forces reshaping our industry.



Are the barriers to commercial risk insurmountable? No, they are not.

    In the first part of our series, we talked about the barriers to commercial risk. But, there are also many reasons that it is an opportunity worth pursuing.

    The future of value-based care

    Medicare and Medicaid risk is progressing (slowly) – but commercial risk will determine whether the industry tips toward a new cost and quality standard.

    What makes commercial risk possible?
    • Everyone actually wants lower-cost care (while maintaining or improving quality).
    • There are obvious cost-saving opportunities today.
    • And, there are less obvious opportunities that can have a tremendous impact.
    • Commercial payers follow CMS's lead on alternate payment models—and CMS is bullish on risk.
    • We're betting on change—VBC is just one option.

    Parting thoughts

    An overnight shift to commercial value-based care isn’t going to happen. But there are clear opportunities worth pursuing.

    The question of commercial risk also has larger implications for how the lines of business intersect or diverge. Medicare and Medicaid are headed to risk. Progress is slow, but at this point, probably committed enough to keep going. Commercial is still more of an open question.

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