Module 0
Belong & Risk-Bearing Context
Understand what it means to be a risk-bearing entity and why Belong's business model is fundamentally different from traditional health plans.
What Is Risk-Bearing?
A risk-bearing entity takes on financial responsibility for a defined population's healthcare costs. If Belong keeps members healthier and spending below a benchmark, they earn shared savings. If costs exceed the benchmark, Belong owes money back to CMS.
This is fundamentally different from a fee-for-service model where providers get paid per visit regardless of outcomes. Belong is incentivized to invest in preventive care, care coordination, and member engagement.
ACO REACH vs. Medicare Advantage
| Feature | ACO REACH | Medicare Advantage |
|---|---|---|
| Payer | CMS (Traditional Medicare) | Private insurer (e.g., Humana, UHC) |
| Risk Model | Benchmark-based shared savings/loss | Capitated premium revenue |
| Member Choice | Any Medicare provider | Network-restricted |
| RAF Impact | Affects benchmark directly | Affects plan premium revenue |
Knowledge Check
Question 1 of 3
What does it mean for Belong Health to be 'risk-bearing'?
💡 Reflection: In your own words, why does Belong care so much about keeping members out of the hospital?