Setting the Stage for Payment Reform: Updating New York's Regulations on Risk Transfers Between Health Plans and Providers

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Agreements between insurance plans and health care providers have become increasingly common in New York as the State continues to move toward value-based payment. The regulations overseeing these risk-transfer agreements are complex, and the prospect of standardizing them has numerous policy and regulatory implications in terms of licensing, financial review, and consumer protection.

This timely report provides an overview of the current rules on risk transfers (as well as historical context for them), and concludes with a checklist of issues for policymakers, State regulators, health plans, providers, and other stakeholders to consider in updating the current regulatory system.

This work was supported by the New York State Health Foundation. Support for the United Hospital Fund's Health Insurance Project is provided by EmblemHealth.