Navigating to a Post-COVID-19 Financial Reality in Healthcare

The shift toward value-based payment has seen many primary care practices move into accountable care organizations (ACOs) or clinically integrated networks (CINs) to participate in shared savings arrangements. The next step, Nyberg said, is those ACOs reaching out to cost-conscious specialists to participate since many of the cost drivers for primary care are specialists. Specialists are also moving toward forming their own CINs, which will shift projections of their financial recovery as revenue changes.

One interesting model Nyberg has seen comes from Blue Cross Blue Shield of North Carolina, which promotes an “Accelerate to Value” program to encourage practices to join an ACO and move toward capitation. The BCBS program would keep payments at 2019 levels through 2021, but on the contingency that the practice remains independent, join an ACO by the end of 2020 and consider a capitation agreement effective Jan. 1, 2022.