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Absent a subsidy from their employer, health insurance payment rates are the primary driver of physician revenue and income. This webinar is a comprehensive, first-time-ever look at the subject from the viewpoint of the appraiser or litigation expert, with numerous real-world examples.
Program Agenda
Employer-sponsored insurance:
Setting premiums;
Allocating the cost to employers and employees;
Types of plans; and
Self-insured plans
Antitrust issues in insurer market concentration:
Individual state examples.
Impact on discount rate;
Affordable Care Act—Obamacare;
Plan types—metal tiers;
Rating rules;
Subsidies;
Impact on individuals not eligible for subsidies;
Medical loss ratios (MLR); and
Impact on valuation.
Capitation:
Defined;
Background;
Alternative payment structures;
Situations where encountered;
Funds flow;
Terminology;
Types; and
Rate setting.
Government programs:
Traditional Medicare;
Medicare Advantage:
Enrollment;
Reasons for popularity; and
Direct contracting model.
Accountable care organizations:
Background;
Antitrust, antikickback, and Stark law waivers; and
Structure.
Valuation considerations of government programs;
Hospital price transparency legislation;
Medicaid:
Described;
COVID-19 era changes;
“Expansion” post-ACA;
Federal and state cost-sharing; and
Managed care.
Program summary.
Learning Objectives
Understand how health insurance premiums are derived—and who wins and who loses;
Learn the four insurance markets—individual, small group, large group, and self-insured—and the type of insurance products they sell;
Introduction to capitation, one of the least understood aspects of physician valuation; and
Experience an in-depth look at government-sponsored health insurance programs.
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