Answer: The program will significantly reward physicians who actively coordinate and monitor care while effectively guiding high-risk members to receive care in high-quality, cost-effective settings.
Rewards to PCPs who actively coordinate and provide high-quality care include:
- 12 percentage point increase added to current fee schedule
- New fees for developing care plans for select patients with certain chronic or multiple conditions that put them at risk and for monitoring progress against those plans
- Additional fee schedule increases based on physicians’ engagement with their patients, the quality of care delivered to their entire cohort of patients, and actual aggregate costs of care compared to expected costs
