decisionhealth Newsletters, Part B News - 2017 Issue 2 (February)
Beyond QPP: Check your readiness for insurer-based physician incentive programs
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Article Overview
This article covers non-federal physician incentive programs offered by commercial payers and Medicaid programs, with an emphasis on how these arrangements relate to broader value-based payment efforts. It is relevant to physicians, practice managers, and coding/reimbursement professionals who want to understand the general structure of payer incentives, common participation requirements, and how practices can evaluate whether a program fits their patient population and operations.
Why This Topic Matters
Payer-based incentive arrangements can affect practice revenue, reporting obligations, and readiness for value-based care participation. Understanding the types of programs available and the broad factors practices should evaluate can help organizations identify opportunities without overcommitting to arrangements that do not fit their patient mix or workflow.
Article Sections
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Physician payments
Introduces non-federal incentive programs and describes how payer-sponsored arrangements can supplement physician payments. It also highlights examples of programs from commercial insurers and a Medicaid-related context.
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Be prepared to transform
Discusses common participation expectations tied to practice transformation and readiness for value-based care models. It describes the kinds of operational preparation practices may need before joining such programs.
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3 transformation steps
Outlines general preparation themes for practices exploring insurer-based incentive opportunities. The section focuses on evaluating payer offerings, assessing practice fit, and considering Medicaid-related options.
What You Will Learn
- How insurer-based incentive programs differ from federal quality payment initiatives in broad terms
- What kinds of practice capabilities are often associated with payer-sponsored value-based arrangements
- How practices can think about readiness before pursuing a non-federal incentive program
- Why Medicaid-related incentive opportunities may also be relevant to some practices
Who Should Read This
- Physicians
- Practice administrators
- Medical billing and coding professionals
- Revenue cycle managers
- Healthcare consultants
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