What is Payor/Provider Convergence and What Does It Mean For You?

19 December 2022 Health Care Law Today Blog

Author(s): Jeffrey C. Thrope JillAllison Opell Alexis Finkelberg Bortniker Morgan J. Tilleman Jessica E. Joseph Larry S. Perlman Anil Shankar Michael J. Tuteur Alexis P. Robertson Adam J. Hepworth Nick J. Welle

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.

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