Managed Care Business Models 101 – Digital Therapeutics & Health Technology



Everyone should be able to walk out of this session feeling empowered by having learned the basic flow of funds (starting at the payer).

About this Event
Healthcare flow of funds explained. Managed Care 101 for healthcare entrepreneurs seeking to do business in the California market. Session led by Alex Yarijanian, CEO Carenodes.

The aim: providing healthcare entrepreneurs with a framework within which they will find their place in the business value chain.

Topics covered in this session are as follows:

1. Managed Care Mind
Managed care: ‘utilization management’
Payment: Volume shift to value
Quality (‘value’) measured
Patient experience
Clinical outcomes

2. Lines of Business aka ‘LOB’ (funding source)
Medicare (Traditional Medicare and Medicare Advantage, Parts ABCD)
Medicaid (managed Medicaid, state / federal, Medi-Cal)
Duals (Medicare and Medicaid beneficiaries)
Commercial (on exchange, off exchange)

3. Products (benefit designs)
The spectrum of products: HMO, PPO, POS, EPO, FFS
Business ramifications

4. Difference between ‘LOB’ vs ‘product’

Difference between ‘LOB‘ (Medicare, commercial, etc) vs ‘product‘ (HMO, PPO, etc.)

Source