Value-Based Payment Design

Health insurers have been gradually shifting their providers away from fee-for-service payments and towards various value-based payment models.  But they haven’t yet figured out how best to pay for new digital health technologies–especially for tech-enabled, telehealth clinical care delivery.

While some “solution vendor” startups might contract with a health insurer on a per-member-per-month basis, most “virtual” care providers are paid on a claims-submitted basis.

But many new tech-enabled care providers deliver a comprehensive package of evidence-based direct services, technology, coaching, peer supports, assistive devices, etc. that don’t neatly fit within traditional fee-for-service insurance payment schedules.

And so to help our portfolio clients to get paid for the full scope of services being delivered, we help them design and negotiate alternative payment models that avoid the pitfalls of fee-for-service billing and enable them to get paid for the full value being delivered.

Catalyst’s consultants are experts in managed care payment models, contracting and credentialing.  Our team includes former MCO provider network managers who know the ins and outs of provider contracting–whether brick-and-mortar providers or tech-enabled telehealth provider organizations.