Question: Population health managers assume accountability for selecting appropriate value-based payment arrangements. In upside risk models, the provider shares the savings without the risks of loss.

Population health managers assume accountability for selecting appropriate value-based payment arrangements. In upside risk models, the provider shares the savings without the risks of loss. For example, if the total costs of care are less than budgeted, the savings are shared between payer and provider. If the total costs are more than budgeted, the provider is not at risk of paying. In the downside risk model, the provider shares savings if costs do not exceed the budgeted amount however, they are at risk of paying if costs exceed the budget. However, under bundled payment models, both provider and payer share risks. The provider carries the utilization risk that the patient will utilize additional services than the bundled amount, whereas the payer carries the insurance risk. If you had to select one of the three risk models, which would it be and why?

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