A risk-based contract is a type of agreement between a health insurer and a healthcare provider, in which the provider is financially responsible (or partially responsible) for the cost of providing care to a specific population of patients. The provider is at “risk” or shares in the risk for the cost of care, hence the name.
In this type of contract, the provider is typically a hospital or physician group, and the population of patients is usually defined by a specific condition or set of conditions. The provider is responsible for managing the care of these patients, including coordinating care and controlling costs. In exchange, the provider is typically given a set amount of money to cover the cost of care, and any savings from controlling costs are shared between the provider and the insurer. Risk contracts are often used in managed care and accountable care organizations, and are intended to improve the quality of care and lower costs.
For organizations that take on risk, Vim offers solutions that help improve risk adjustment performance by empowering providers at the point of care.