Risk-Based Primary Care Requires Collaboration, Data Sharing, Insurance Execs Say

Primary care practitioners are working through dramatic change in the business of their profession: More PCPs than ever are working under capitation or risk-based reimbursement arrangements. That trend accelerated as physician employment increased during the worst years of the COVID-19 pandemic, with many doctors selling their independent practices to private equity, insurers or hospital systems.

Although risk-based reimbursement is well established in government books of business, the commercial market is adopting risk-based primary care payment using lessons learned in Medicare Advantage and Medicaid managed care. The transition to commercial risk-based compensation was the subject of a May 23 panel convened by the Primary Care Collaborative, a primary care policy group.

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Peter Johnson

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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