In an interactive session at Becker's 29th Annual ASC Meeting: The Business and Operations of ASCs, Bud Brooks, Chief Development Officer for the Open Network division of Nomi Health, gave a presentation on direct-to-employer contracting. He explained that Nomi Health stands for "no middleman" and aims to facilitate direct relationships between surgical centers or physician groups and self-insured employers.
Mr. Brooks emphasized the importance of transparent, all-inclusive bundles with no copays or deductibles and the elimination of balance billing. He also discussed the potential for facilities or physician practices to control the bundle and distribute the funds. The presentation concluded with a roundtable discussion on the topic.
Editor's note: Quotes have been edited for length and clarity.
Key takeaways:
1. Nomi Health aims to eliminate middlemen and facilitate direct contracting between surgical centers/physician groups and self-insured employers.
Bud Brooks: "NOMI stands for no middleman ... because we believe that the middlemen that you all deal with today are the barriers."
2. Direct contracting allows for transparent, all-inclusive bundles for routine scheduled procedures, eliminating the need for pre-authorizations and simplifying billing and collections.
BB: "We're getting out of the old shell game of billed charges and discounts. ... In this private marketplace, you can send an invoice to get paid, period, without intervening managed care and billing companies."
3. Bundled contracts create a quality component by ensuring the best surgeons and anesthesia providers are involved in each case.
BB: "You want the best knee surgeon on the knee case and so on. We believe this creates a four-way win: facility, physician, employer and patient."
4. Facilities receive the entire payment for bundled procedures and are responsible for distributing it to physicians and eliminating balance billing.
BB: "If the facilities own the bundles, the facility will see the entire payment. ... You have to make sure there's no balance billing at all."