What is multilateral gain/loss sharing?

Multilateral gain/loss sharing is a way of reallocating finances across a local care economy when delivering new care models

What is multilateral gain/loss sharing?

Multilateral gain/loss sharing involves multiple providers and one or more commissioners in a local care economy forming a network to identify and distribute financial gains and losses.

It works by comparing how much commissioners in the network were expected to spend delivering care with the actual amount they spent.

The difference between these two amounts forms the gains/losses pool. This pool is then distributed between all the commissioners and providers in that network.

For example, a reduction in non-elective admissions may lead to an overall reduction in spend across the board. This reduction would form a gains pool that could then be shared among the network, including the provider that has seen a reduction in its activity and the providers in the community that helped achieve this outcome.

Multilateral gain/loss sharing combined with an underlying payment model – such as capitation – defines the overall payment approach.

Help us refine and improve this approach

Some local health economies have already begun to explore how a multilateral gain/loss sharing mechanism can help support the integration of care and drive improved outcomes for patients. We’ll refine the payment example as we learn more from local health economies that implement these new models.

If you’re exploring the use of a multilateral gain/loss sharing mechanism, we’d like to hear about your experiences. Email us at

Multilateral gain/loss sharing in detail

Published 16 July 2015