ABA National (Virtual) Managed Care Institute

October 7, 2020


Jen Johnson, Chief Commercial Officer, Managing Director, Head of Compensation Arrangements, VMG Health

The Future of Risk-Based Arrangements with New Stark & AKS Regulations

With the onslaught of risk-based arrangements flooding the market, healthcare leaders must grapple with both the regulatory challenges of how to structure risk sharing arrangements with physicians, as well as how to determine the amount of value-based compensation that may be paid to physicians, whether directly or through first tier contractor arrangements. The panel will address the new proposed value-based rules, how the proposed AKS safe harbors and Stark exceptions may come into play for risk-based arrangements involving physicians, and what valuators should consider when determining if an outcomes-based payment is (or is not) consistent with fair market value.  The presentation will also address how concepts of “commercial reasonableness” based on traditional metrics of valuing physician work effort might or might not fit within a regulatory regime applicable to risk-based arrangements.