Medicare Advantage Capitation Strategies for Payer-Providers (24H)

In 2021, West Virginia University Health System (WVUHS) announced the creation of Peak Health, a health insurer and health insurance services company headquartered in Morgantown, West Virginia. Peak Health was created to make care more accessible, understandable and collaborative among patients, providers and payers. Peak Health aims to accomplish this by incentivizing payers and providers to keep enrollees as healthy as possible in the lowest-cost setting. The corporate structure provides additional opportunities to move away from fee-for-service reimbursements and toward innovative models like capitation. This will allow WVUHS to decrease the administrative burden from the care process and act as one integrated health system with a strong payer partner.

In this educational session, using Peak Health as a case study, participants will learn how to utilize capitation to advance success in value-based Medicare Advantage programs. Participants will learn about the benefits of this structure, including financial alignment between payers and providers, reductions of administrative expense, and financial and regulatory benefits. Finally, participants will learn ways to structure population health programs to support a health system's success under Medicare Advantage capitation.