Providers across the country are continuing to experience pressure on rates and total-cost-of-care. Most are unlikely to see the growth of commercial and government spending on healthcare to match the rate of inflation. The continuing transition of the U.S. healthcare system to a value-based market has created opportunities for providers and payers willing to take a fresh look at their traditional business models. Health systems are increasingly becoming insurers—launching accountable care organizations (ACOs), building payer partnerships, initiating private-label products, and even launching their own provider-sponsored health plans—and now face the challenge of learning to “think like a health plan”. Payers are increasingly delegating risk through risk bearing entity structures and offering services to providers seeking insurance expertise in understanding and managing patient populations. 

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BDC Advisors has been developing aligned incentive-based contracts between health systems and provider groups, health plans, and employers for more than 30 years. We were the first consulting firm to build a clinically integrated network based on performance-risk contracting and since then, have worked on many engagements on both sides of these risk arrangements. We have expertise in all forms of risk-sharing, value-based contracting, including “bundled payment” contracts, partial and global capitation, and direct ownership of health plan businesses. We also have considerable experience developing different types of partnerships between payers and providers, or groups of providers (e.g., Super-ACOs) being formed to bring population health products to the emerging retail market.