ARTICLE
22 December 2022

What Is Payor/Provider Convergence And What Does It Mean For You?

FL
Foley & Lardner

Contributor

Foley & Lardner LLP looks beyond the law to focus on the constantly evolving demands facing our clients and their industries. With over 1,100 lawyers in 24 offices across the United States, Mexico, Europe and Asia, Foley approaches client service by first understanding our clients’ priorities, objectives and challenges. We work hard to understand our clients’ issues and forge long-term relationships with them to help achieve successful outcomes and solve their legal issues through practical business advice and cutting-edge legal insight. Our clients view us as trusted business advisors because we understand that great legal service is only valuable if it is relevant, practical and beneficial to their businesses.
Payor/Provider Convergence refers to the evolving trend toward value based payments, in which health providers are taking financial risk in their contracts with health insurance companies (Payors)...
United States Food, Drugs, Healthcare, Life Sciences

Payor/Provider Convergence refers to the evolving trend toward value based payments, in which health providers are taking financial risk in their contracts with health insurance companies (Payors), and Payors are becoming more involved in the delivery of care. Some Payors are providing care directly and others are acquiring professional practices. At the same time, some providers are taking financial responsibility for caring for defined populations for a fixed sum of money, and others are entering into a variety of "Value Based" Agreements in which the Provider has upside and/or downside risk if the cost of caring for a defined population differs from the projected cost.

Beyond making sure they are fully informed of the regulatory requirements in these new roles, Payors and providers need to learn to think about health care services and payments from each other's point of view. At an upcoming program, we will set the stage by reviewing terms and issues that are seen differently by Payors and providers, but which the converged Payors and providers should be able to see differently as they enter their new roles. This will set the stage for an in-depth program covering the evolving regulatory issues faced by converged Payors and providers. In addition, there will be a session on "Promoting DEI in the Workplace: What to do and where are we headed?".

The program will take place on January 26, 2023 at the Los Angeles Office of Foley & Lardner, LLP. A group of presenters from Foley & Lardner, LLP (Foley) and Mazars will hold the first "What You Should Know About Payor/Provider Convergence" program on the West Coast. A link to the Agenda for the Program is available here. We will offer CLE and DEI CLE credits for this program.

Participants will be invited to a welcome reception on Wednesday, January 25, 2023 at Foley's Los Angeles office, to network and to learn more about the attorneys from Foley's Health Care and Insurance Practice Groups and Foley's Payor/Provider Convergence Area of Focus.

To register for both the reception and the program, please click here.

If you have any questions, please reach out to Patrick Brennan at pbrennan@foley.com.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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