Health Law Highlights

Using A Value-Based Enterprise to Integrate Specialists and Primary Care: Taking Value-Based Care to the Next Level

Summary of article from Nelson Mullins Riley & Scarborough LLP, by Mike Segal, Edward White:

Within the value-based healthcare model, the majority of medical expenses come from specialist sectors operating under traditional fee-for-service payment models. A potential solution to this challenge could be the implementation of a Value-Based Enterprise (VBE) that promotes mutually beneficial contractual relationships between primary care providers and specialists in a low-risk regulatory environment. Thanks to new regulations under the Stark Law and Anti-Kickback Statute, a VBE can act as an “Innovation Center,” allowing healthcare professionals to develop their own initiatives aimed at providing high quality, cost-efficient care. It is proposed that Primary Care Provider (PCP) Risk Arrangements embrace patient attribution, apply for capitation payment arrangements, contract with high-quality specialists, and pay these specialists under a value-based framework. This system can help control total care costs and improve patient outcomes.