A
growing num-
ber of self-
insured
employers are bypass-
ing health plan admin-
istrators and contract-
ing directly with
providers. It's known
as "direct contracting"
when employers side-
step HMOs and go
right to the source of
care — physicians and
other providers. Could
this opportunity be
right for your facility?
Before planning your own direct contracts with local or regional
employers, know the answers to these 5 questions.
Do your existing network agreements
and payer contracts allow for direct contracting?
Facilities and physicians who are interested in direct contracting
should review all of their current network participation agreements
and payer contracts to ensure that they don't contain restrictions on
making such arrangements with employers.
These types of restrictions can be found in non-compete or exclusiv-
ity clauses, which often require that all contracting be done through a
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1 4 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 1 6
Tapping Into the Self-Insured Employer Market
Direct contracts with employers cut out insurance's middleman.
Legal Update
Thomas L. O'Carroll, JD, and Angela M. Rust, JD
• SURGERY, STRAIGHT FROM THE SOURCE The direct contracting of health care can
be a lucrative arrangement for providers and employers.
