True or False
In 2023 there was about $186 million paid out in provider incentives at the Corporate Level
These two individuals are the primary points of contact for the Corporate Payment Innovations Team.
Denise Ritcher and Patrick Solon
In order to incentivize a provider such as a GI specialist the provider incentive program would need to be administered by which entity?
Providers experience only positive gain without the risk of loss or repayment because these programs are considered what?
Up-side Only
Provider incentives at Centene are only administered at the Corporate level.
False - What is false?
In order for a health plan to participate in the corporate administered provider incentive programs they must be on this platform
Amisys
What is Enhanced Total Cost of Care (TCOC)?
This safety-net program uses an additional universal Core Measure Set to apply a secondary quality adjustment, allowing providers to earn extra money back.
This acronym is frequently used when discussing Provider Incentives for Medicaid.
P4P
Provider incentive payments from the Corporate-administered program are sent out four times per year
False - What is false?
To incentivize a specialist provider, incentives must be administered at this level
The Health Plan
What is Pay Per Member (PPM)?
This payment methodology only pays for members who are compliant with a measure.
What is Q.RA?
This analytic tool shows total maximum earned dollars at the executive summary level, but loses detail when filtered by specific providers.
The budget impacted for provider incentive payments depends on whether the program is administered at the corporate or health plan level.
False - What is false?
Provider incentives often aim to improve patient outcomes and this measure of efficiency
Cost-effectiveness
What is Per Member Per Month (PMPM)?
This payment methodology pays based on the entire population of assigned members.
What is Provider Analytics?
This analytic tool contains actual payment dollars and provides more specific denominators at the provider level.
For health plans participating in the corporate-administered program, each year they select the measures on which providers can be incentivized and share their chosen list with the Payment Innovations Team.
True
These financial rewards encourage providers to meet quality or performance benchmarks.
Provider incentives
Corporate-administered provider incentive programs are limited because they only pay this type of provider.
Primary Care
What is Alternative Payment Models?
This payment approach moves healthcare beyond fee-for-service and ties reimbursement to quality, outcomes, and cost efficiency.