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  #21  
Old 03-13-2018, 12:58 AM
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George Frankly George Frankly is offline
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I don't know how many alternative payment arrangements you're in but if you negotiate directly you can consider adding bonus payment (contingent or non-contingent) based on your providers' completion rates that affect plan revenues. I'm not sure whether or not it matters quite as much for oncologists as primary care docs, but if it is then I'd say try to get that one in there.
We definitely negotiate directly. What do you mean when you say 'completion rates that affect plan revenues?'

If we can get a win/win with a payer, then I'm in.
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Old 03-13-2018, 07:17 AM
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Three legged stool has been thrown around with the ACA individual market to show how the mandates, subsidies, and guaranteed issue clause work together.

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Old 03-13-2018, 10:52 AM
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We definitely negotiate directly. What do you mean when you say 'completion rates that affect plan revenues?'

If we can get a win/win with a payer, then I'm in.
Well primary care doctors who are assigned as primary can be given responsibility of those patients and their Medicare metrics. For example if the patients are eligible for colorectal cancer screening then the primary care office would be rewarded with a PMPM or two tiers of PMPM for different levels of achievement. Typically indexed to the Medicare benchmark.

If your group has patients in care that need Medicare checkboxes filled or something similar, then depending on your current agreements you can work in "quality" metrics into your contracts to show an incentive to your doctors and the plan.
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Old 03-28-2018, 03:49 PM
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I don't know about win/wins with payers, but there are some when payers are excluded, such as primary care paid for directly (w/o 3rd party payers). More time with patients, much lower administrative hassles... Doctors say it's what they envisioned doing when they went to med school. The 1-2 hours of admin work for each hour of time with patients is not what they signed up for.
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