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Date(s) - Thursday, June 15, 2017, 1:00 PM - 2:00 PM

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Thursday, June 15, 2017

1:00PM – 2:00PM ET

Meeting ParticipantsReadyTalk User Guide

MAC Session 6: Episode Budget and Price

The purpose of this meeting is to explore the broad issues, challenges, and options to consider when creating a methodology for setting episode budget and price for maternity APMs.

Session Materials

Session Goals

  • Discuss and understand episode budgeting, including:
    • Options for determining the basis of the budget
    • Flat fee or risk-adjusted budgets
    • Risk models including shared savings, shared risk, and full risk
    • How quality may be incorporated into the financial risk model, or how it may be used independent of the risk model
    • Other factors that could adjust the budget (i.e., margin, fee to protect from underuse of services, stop-loss)
  • Ask questions of and interact with each other and expert discussants who can speak from the provider and payer perspectives on how their organizations established episode budgets and prices.
  • Identify leading and promising practices for further action
  • Commit to action steps specific to this topic
  • Solicit participant feedback and any specific requests for future meetings

Expert Discussants

  • Francois DeBrantes, Vice-President and Director at Altarum in the Center for Payment Innovation
  • Andy Allison, Senior Expert in the Health Care Systems and Services (HSS) practice at Mckinsey


To achieve the goal of better care, smarter spending, and healthier people, the U.S. health care system must substantially reform its payment structure to incentivize quality, health outcomes, and value over volume. The Health Care Payment Learning and Action Network (LAN) was established as a collaborative network of public and private stakeholders, including health plans, providers, patients, employers, consumers, states, federal agencies, and other partners within the health care community.


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