The transition from fee-for-service to alternative payment models continues with the Centers for Medicare and Medicaid Services leading the way and commercial payors following suit. This shift in payment dynamics has created new entities that are willing to bear risk, as well as new payment models for physicians. Transaction activity includes assessing health plan assets, establishing accountable care organizations (ACO) or clinically integrated networks (CIN), and seeking physician alignment through innovative compensation models or working with practices accepting capitated payment models.

VMG Health understands the unique regulatory challenges and managed care industry dynamics to move your transaction forward, whether it be a health plan acquisition or joint-venture between payors and providers. Further, if your organization is contemplating alternative payment models, such as pay for performance, shared savings models or bundled payments, you can count on VMG Health to stay current on the latest market trends, regulatory nuances and fair market value requirement. Lastly, risk-based contractual arrangements, such as co-management and hospital efficiency incentive programs continue to grow and require FMV documentation.

Healthcare provider organizations are increasingly taking on risk for management of lives. This can be of material benefit to those organizations by ensuring a more stable revenue base but can also be very risky if the lives are not managed appropriately. VMG Health advisors have a long history of assisting healthcare providers in assessing options for increasing emphasis on risk-bearing entities. VMG Health has helped develop CINs, ACOs and Bundled Payment Programs, among others. Further, VMG Health has in-depth expertise related to leading major payer negotiations and establishing provider networks capable of earning shared savings, quality bonuses and/or premium savings.

Coding & Compliance

With new payment models comes new coding requirements. It is not unusual for providers to miss some of the essential coding rules resulting in a lack of revenue integrity. Understanding the new Risk Adjusted Coding/Value-Based Medicine and HCC Documentation is essential for providers to be reimbursed for their services. VMG Health provides best coding practices documentation to coders, providers and auxiliary staff. Properly understanding risk-based coding is absolutely essential for both recognizing the appropriate revenue for services rendered and for compliance purposes. VMG Health can also help implement a coding and compliance program for your risk-based organization.

Trending Strategic Needs for Risk-Bearing Organizations & Health Plans

Relevant Engagements

VMG Health was engaged to render its opinion on the fairness, from a financial point of view, of the consideration to be paid by a subsidiary of Blue Shield of California related to the acquisition of the assets and operations of Brown & Toland Physicians.
VMG Health was engaged to render its opinion on the fairness, from a financial point of view, of the consideration to be paid by Kaiser Foundation Health Plan of Washington related to the acquisition of the assets and operations of Group Health Cooperative.

Risk-Bearing Organization & Health Plan Experts