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Risk Sharing Strategies for Disease Management Programs

机译：疾病管理计划的风险分担策略

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摘要

Stand-alone disease management (DM) programs are enjoying unprecedented growth, as both insurers and employers turn to DM solutions to increase employee productivity by managing the risk of chronic and/or potentially catastrophic illnesses, in the hopes of ultimately controlling rising medical costs. Despite the fact that DM companies are growing rapidly, not all plans and plan sponsors are sold on the benefits that such firms can offer. With few outcome standards established for DM programs, potential clients are sometimes reluctant to invest in a "new" program. Nevertheless, there are two compelling strategies that DM companies can offer to potential clients to reduce their financial risk. The first is basing fees on outcomes. It has become common for DM companies to guarantee savings targets by putting all or part of their fee at risk. The downside of basing fees on performance projections is, of course, that the DM company assumes risk. Fortunately, there are methods to mitigate risk that can protect the DM company from sustaining a large loss if it fails to meet its projections. This technique improves the company's overall risk position and simultaneously protects the health plan or employer by increasing the solvency of the DM vendor.
机译：独立的疾病管理（DM）计划正以前所未有的速度增长，因为保险公司和雇主都转向DM解决方案，通过管理慢性和/或潜在灾难性疾病的风险来提高员工的生产率，以期最终控制不断上涨的医疗成本。尽管DM公司发展迅速，但并非所有计划和计划发起人都是以此类公司提供的收益出售的。由于针对DM计划建立的结果标准很少，潜在客户有时不愿投资于“新”计划。尽管如此，DM公司可以提供两种引人注目的策略来降低潜在客户的财务风险。首先是根据结果收取费用。 DM公司通常通过将全部或部分费用置于风险中来保证节约目标，这已成为普遍现象。当然，基于绩效预测收取费用的不利之处在于，DM公司承担风险。幸运的是，有一些降低风险的方法可以保护DM公司，使其无法实现预期的损失。该技术可提高DM供应商的偿付能力，从而改善公司的整体风险状况，并同时保护健康计划或雇主。

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