Risk Sharing

Risk sharing is a concept in healthcare financing that involves sharing the financial risk of providing healthcare services between payers (e.g. insurance companies, government programs) and providers (e.g. hospitals, doctors).

In a risk-sharing arrangement, providers are incentivized to deliver high-quality, cost-effective care, as they bear a portion of the financial risk for the care they provide. If they are able to deliver care in a cost-effective manner and avoid unnecessary treatments and procedures, they can earn a share of the savings, but if the cost of care exceeds the budget, they may also be responsible for some of the financial burden.

Risk-sharing arrangements can take various forms, such as accountable care organizations (ACOs), bundled payment programs, and capitation arrangements. These models are often used as a way to incentivize providers to prioritize quality and efficiency in care delivery, while also ensuring that they have the necessary resources to provide high-quality care to their patients.

Overall, risk sharing is a key aspect of value-based care, as it helps to align the financial incentives of payers and providers, and promotes high-quality, cost-effective care for patients.

Risk-bearing organizations utilize Vim’s Diagnosis Gaps solution to increase risk adjustment accuracy. Payer-sourced suspected diagnoses are embedded directly into provider EHRs, surfacing patient-specific condition gaps and assisting providers in quickly and easily taking appropriate actions for accurate and efficient risk adjustment processes.