Managed Care / Value-based Care Risk

As the U.S. healthcare payment system continues to evolve away from traditional fee-for-service and toward managed and value-based care models, addressing the exposure to financial risk that both providers and payers face is a major concern.

This risk takes many forms: in capitated contracts between physician groups and managed care organizations, the vulnerability to catastro­phic medical claims by health plans and HMOs, and within the array of two-sided risk models created by the Center for Medicare and Medicaid Innovation. At Connected Risk Solutions, we deliver innovative financial risk mitigation strategies and re/insurance products to our clients across the breadth of the healthcare industry.

Who We Serve

Healthcare providers
  • Physician groups
  • Hospitals
  • Health systems
  • Independent practice associations (IPAs)
  • Clinically integrated networks (CINs)
HMOs & Health Plans
Managed Care Organizations (MCOs)
  • Management services organizations (MSOs)
  • Physician-hospital organizations (PHOs)
  • Integrated delivery systems (IDS) and organizations (IDOs)
  • Group purchasing organizations (GPOs)
Accountable Care Organizations (ACOs)
  • MSSP, Medicaid and commercial
  • Medicaid

  • Commercial

CMS Two-Sided Risk Models
  • Enhancing Oncology Model (EOM)
  • Kidney Care Choices Model (KCC)

Specialized Re/Insurance Solutions

  • Healthcare providers
    • Specific and aggregate provider stop loss
    • Episodic coverage for Bundled Payments models
  • HMOs and health plans
    • HMO reinsurance
    • Medical excess reinsurance
    • Quota share and structured reinsurance
  • ACOs
    • Specific and aggregate stop loss reinsurance
    • Surety bonds as an alternative reimbursement mechanism to letter of credit or escrow funds
  • Alternative Risk Financing
    • Inner aggregate, aggregating specific deducible and zero-swing programs
    • Captives
  • Property & casualty coverages for all classes of providers and payers
    • Professional and general liability
    • Managed care errors & omissions
    • Management liability
    • Cyber risk

Our Service Capabilities

We support our clients’ re/insurance programs with comprehensive data management and analytics, claims administration, coverage review and premium payment/claims reimbursement processing services. These tools enable us to maximize efficiency, and to inform executive decision-making around optimal program design.

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Our Insights