COPE Health Solutions will provide an overview of the different components of contracts between providers and health plans or IPAs/ACOs such as capitation, quality improvement kicker, fee for service, shared savings, etc. and demonstrate how these contracts evolve from fee for service to value based payment arrangements. We will then dive into the details of the funds flow models of these contracts and provide examples of how dollars flow through all of the different stakeholders such as the health plans, risk bearing entities, and providers.

Course Overview

Introduction to Management and Distributions of Funds
» Components of MCO Contracting
» Division of Financial Responsibility
» Medical Loss Ratio
» MSO Services

Types of Provider Reimbursement Models
» Fee-for-Service
» Shared Savings
» Provider & Full Capitation
» Global Risk Model

Funds Flow Models
» Traditional FFS Funds Flow
» FFS + Shared Savings / Risk Funds Flow
» Capitation Funds Flow
» Provider Incentive Design
» Tools for Contracted Provider Funds Flow
» Funds Flow for Employed Providers

Case Study
» Northwood Diabetes Group