PODCAST: Direct Employer Contracting for Medical Services

Employers Can Enter Into Direct Contracts with Doctors, Hospitals and Other Healthcare Facilities for Medical Services for Members of Their Employee Health Plan.

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Texas CEO Magazine 2016 Economic Forecast: Dallas - Texas ...

BY ERIC BRICKER MD

Reimbursement Typically Takes the Form of a Bundled Payment or a Lower Rate of Fee-for-Service.

Employers with Greater Than 500 Employees Tend To Engage in Direct Contracting.

Mid-Market Employers with a High Concentration of Employees in One Geographic Area Tend to Engage in Direct Contracting as Well.

The Employer Frequently Uses an Independent TPA to Process the Claims for the Direct Contract.

Also, the Employee Health Plan Changes the ‘Benefit Level’ Such that Care at the Direct Contract Facility is Often at $0 Out-of-Pocket Cost for the Member.

Engaging the Plan Members with Navigation Services is Helpful to Make the Experience Integrated with the Overall Health Plan Offerings.

YOUR THOUGHTS ARE APPRECIATED.

CITE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

THANK YOU

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