Episodic Payment Solution for Payors
Experience a scalable, physician-aligned, warranty-backed model proven to perform where traditional bundled payment approaches have fallen short.
Enhancing Surgical Value Through Payor and Provider Alignment
Achieving high-quality surgical outcomes at lower costs requires more than a payment model—it takes strong alignment across payors, physicians, and surgical facilities. NueHealth facilitates that alignment by operationalizing full-risk episodic care through regional provider networks, aligned incentives, and robust clinical integration.
We reduce administrative friction across the entire episode of care, helping payors improve cost-efficiency, ensure quality, and enhance member satisfaction without disruption to their existing systems.
Full-Risk Episodic Payment Management Model
We Carry the Risk, You See the Results
We partner with payors to establish full-risk, prospective episodic payment agreements—then manage everything from provider network integration to claims adjudication and performance tracking.
At the core of this model is our high-performing network of NueRisk Partners™ physicians, committed to delivering high-quality care at lower costs. Each episode is backed by a 90+ day warranty and supported by our Muve® clinical program, an evidence-based care framework that reduces variation, enhances outcomes, and captures key data across the entire care journey.
| NueHealth | Traditional Bundles | |
| Risk Management | Full risk assumed by NueHealth and backed by a warranty. | Risk is largely held by surgical facilities, limiting scalability and efficiency. |
| Funds Distribution | Centralized through NueHealth as the convener. | Managed by surgical facilities, often leading to decentralized operational inefficiencies. |
| Scalability | Contracts with multiple surgical facilities, without being tied to a specific facility. | Restricted to surgical facilities holding bundle ownership, reducing flexibility. |
| Alignment with Physicians | Physicians are incentivized for quality outcomes and cost-effective care. | Physicians may lack accountability for quality and outcomes. |
| Quality Reporting | Access to the Muve clinical program for advanced tracking and quality improvement. | Inconsistent solutions for monitoring patient progress across the care continuum. |
| Market Entry | Scalable model given streamlined contracting and risk management infrastructure. | Slower adoption due to limited healthcare facilities participation and risk-management structure. |
Turnkey Solution for Quality, Savings, & Operational Ease
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Enhanced Member Satisfaction
Streamlined care coordination and high-touch engagement guide superior member experiences.
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Expanded Provider Networks
Broader access to top-tier providers increases member choice and improves care accessibility across your network.
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Muve Clinical Program
Evidence-based protocols and care pathways mitigate risk and guide consistent outcomes.
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Site of Service Optimization
Aligned provider incentives ensure care is delivered in the most appropriate, cost-effective surgical settings.
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Claims Adjudication
End-to-end claims adjudication reduces administrative complexity and streamlines episodic payment management.
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Cost Predictability & Savings
A 90+ day episode-of-care warranty delivers guaranteed savings and reduces financial variability.
Helping Payors Succeed in an Evolving Landscape
Surgical spend and the overutilization of post-operative care remain among the most costly and under addressed challenges payors face, especially as expectations from employers and health plan members continue to rise. Our model is a practical solution for payors to operationalize full-risk episodic payments, overcome adoption barriers, and succeed in the inevitable shift to value-based care.
The Result:
- Satisfied employers and members
- Increased retention and health plan loyalty
- Simplified administration
- Future-ready network built for advanced payment models
