Contracting
When will Connected Care Partners enter into risk contracts with payers or employers?
Connected Care Partner’s first contract will be with the NMHS employee health plan (administered by Acclaim); however, this will not be a traditional contract and will evolve into an incentive contract as the CIN sets quality targets, builds informatics infrastructure and expertise develops within Connected Care Partners. Early pay for performance contracts will have only potential for performance improvement and pay for performance shared savings arrangements. Eventually, Connected Care Partners may enter into well considered full risk contracts when systems are in place to manage risk.
Will Connected Care Partners pursue Medicaid contracts?
Managed Medicaid contracts will be reviewed on a case by case basis but will not be a targeted payer.
Will there be reimbursement reform, i.e. pay for performance, bundled payments, episodic payments, capitation?
Eventually, Connected Care Partners may seek contracts with the value proposition that could include bundled payments, episodic payments or capitation. However, the initial focus of the contracting will be contracts that focus on pay for performance on clinical improvement or efficiency metrics and shared savings programs that reward overall decrease in the costs of care. Later as Connected Care Partners matures in its informatics and quality
capability, more complex incentive contracts may be considered based on the needs of payers and employers.
Can I opt out of payer contracts that Connected Care Partners negotiates?
1. Primary care providers (physicians and advanced practice clinicians) may only participate as a full participating member. Specialists have the option to join as a full participating member. Connected Care Partners will contract on behalf of the member with health plans, third party payers and government health care programs for both incentive and non-incentive programs.
2. Or, specialty providers may join as a limited incentive participating member. As a limited incentive participating member, specialty physicians will retain independent contracting authority with health plans, third party payers and governmental programs, but agree to participate in all incentive programs. However, participation in any contracts is not guaranteed and will be decided on a case by case basis.
