Payment & Delivery Models

Withholds as a payment model

Payment withholds (PDF) are a long-standing type of risk arrangement. Under a withhold arrangement, the health plan withholds a portion of the payments that are otherwise owed to you and other participants. These withhold amounts are then placed in one or more risk pool funds held by the health plan.

 Whether or not all or a portion of the withhold is paid back to you depends on how you and all participants perform against a predetermined utilization budget set by the health plan.

Key takeaways

  • Although withhold arrangements have not been as prevalent in recent years, payers and employers may revisit their use as a means of slowing the growth of health care costs.
  • Since withholds may be used with a broad range of reimbursement methodologies, you should look for withhold provisions in every managed care contract.
  • You may only receive a portion of withheld monies if there is a pool surplus. You should carefully analyze the financial impact on your practice if there are risk pool deficits.