Promoting Episode-based Provider Payment Through Employee Health Benefit Design

Prepared in partnership with Signify Health

Employers sponsoring group health plans face the ever-growing challenge of rising health care costs and the increasing expenses they place on the plans and their enrollees alike. To respond to these pressures, employers have experimented with a variety of insurance design options and payment models to varying degrees of success.

However, research and field implementations show that episode-based payment arrangements—in which plans and groups of providers agree to a flat fee for all services related to a single episode of care—present an opportunity to stem these rising costs while increasing the coordination of care in the fragmented U.S. health care system. To achieve the full potential of episode-based payments, plans and providers must align their goals and incentives with those of the employees (and patients) they serve.

In a new white paper prepared in partnership with Signify Health, Manatt Health describes how employers can design “episode-based benefit plans”: creative cost-sharing frameworks that give enrollees financial incentives to join with employers and episode-of-care contracted providers in promoting the episode-based care model. The paper explains how this simple framework, coupled with strong transparency and patient education tools, can motivate patients to make wise health care choices that benefit themselves, plans and providers alike.

To read the full white paper, click here.

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