Alternative Payment
Model Valuation
Fair market value and commercial reasonableness assessments of
provider network revenue distributions.
Challenges
• Network payments to physicians
must comply with fraud and abuse
laws and IRS rules
• Limited regulatory guidance
• Minimal market data on which to rely
• Physician behavior must be properly
incentivized
Benefits
• Confidence in compliance of planned
network revenue distributions
• Appropriately designed plans
incentivizing desired behavior change
necessary to achieve organizational
population health goals
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