We are a direct contracting and bundling entity that works on free market principles and is achieving exceptional results from providers. Pre-negotiated deals have the same level of disruption as retrospectively negotiated deals, but are far less confrontational and afford the ability for providers to step up and do the right thing proactively.
When I approach providers we leave the room shaking hands and agreeing to conquering the cost issue TOGETHER. The mess we are in is due in large part to fee for service and the completely unnecessary adversarial relationship between providers and payers. As an industry we stoked that fire over the past 25 years though ever expanding claims denials and “shared savings” monitization strategies. While I am personally ambivalent to RBP as a necessary tool to deal with exaggerated out of network claims, I think a blending of RBP and pre-negociated fixed rates is far more powerful and vastly more likely to achieve the desired outcome (a sustainable healthcare system and cost reductions) than is RBP alone. For many providers RBP is throwing gas on the proverbial fire. I talk with hundreds of providers every month, and not ONE has ever told me how much they love RBP. Done right RBP is an essential tool in controlling costs.
Fixing healthcare is NOT possible without getting providers on board as collaborators. Making physicians and nurses the enemy is a losing proposition, not only for the benefits industry but more importantly for the medical public. Every market is different and every market requires a locally adjusted solution that sees the needs of the community. Most of America is small town America. In small town America healthcare options may be very limited. Maintaining health, QUALITY local healthcare is very important and a balance between affordability and sustainability is required of any responsible effort to reform.
RBP vendors that want to take a blended approach are encouraged to check us out.