Related Experiment Video
Updated: Feb 12, 2026

14:14
The Innovation Arena: A Method for Comparing Innovative Problem-Solving Across Groups
Published on: May 13, 2022
6.4K
A Conversation With Mai Pham, MD. Payment Innovation at Anthem: Downside Risk Will Be Rewarded.
Summary
Insurers will phase out care-coordination fees for providers in upside-only arrangements. This strategic shift aims to encourage value-based care adoption and reduce financial incentives for suboptimal payment models.
Area of Science:
- Healthcare economics
- Health services research
- Value-based care models
Background:
- Analysis of current healthcare payment structures.
- Examination of insurer-provider financial relationships.
- The role of care-coordination fees in provider reimbursement.
Discussion:
- Insurers are signaling a shift away from unconditional care-coordination fees.
- Providers in "upside-only" arrangements may lose supplemental income.
- This change encourages a move towards more comprehensive value-based care.
Key Insights:
- Care-coordination fees are not permanent entitlements for providers.
- Financial incentives are being recalibrated to promote better patient outcomes.
- The move signals a strategic realignment in healthcare reimbursement.
Outlook:
- Anticipated increase in adoption of risk-bearing value-based care models.
- Potential for revised provider contracts and negotiation strategies.
- Long-term implications for healthcare system efficiency and quality.
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