EP 175: Value-Based Pricing Models: Group Health Plan Considerations

In this episode, Suzanne Spradley and Chase Cannon explore the growing interest in value-based pricing models for health plans, including bundled payments, capitation, and outcome-based arrangements. The two discuss how these models aim to connect payment with quality and cost outcomes, while highlighting the ERISA fiduciary, contracting, PBM transparency, HIPAA, and plan document considerations that sponsors should evaluate before adopting them. Listeners will come away with a practical understanding of both the promise and the compliance challenges of moving beyond traditional fee-for-service arrangements.