Aligning Reimbursement & Purchasing

• Health home providers receive $8.50 per PMPM: $8.00 through the health homes program in addition to an existing $0.50 PMPM to provide care management services under the state’s 1915(b) wavier.
• PCNAs receive $9.50 PMPM for each health home patient.

• Primary Care Medical Provider (PCMP): $4 PMPM*
• Regional Care Collaborative Organization (RCCO): $13 PMPM
• Statewide Data and Analytics Contractor (SDAC): $3 PMPM

Once a RCCO shows cost neutrality, $1 PMPM is withheld from both the PCMP and RCCO, creating a shared quarterly incentive payment pool. The $1 PMPM can be recouped by each entity by meeting Key Performance Indicators: reduced emergency room utilization; reduced hospital readmissions; reduced utilization of medical imaging. A fourth measure, well-child visits, was added in July 2013.
* Pediatric PCMPs cannot receive enhanced payments from both the Medical Homes for Children and the ACC programs. They are only eligible to receive the Medical Home for Children Program performance payments for their patients.
Comprehensive Primary Care Initiative (CPCi): This four-year multi-payer initiative, launched in November 2012, includes ten payers in the Colorado market: Medicare, Anthem Blue Cross Blue Shield of Colorado, Cigna, Colorado Access, Colorado Choice Health Plans, Colorado Medicaid, Humana, Rocky Mountain Health Plans, Teamsters Multi-Employer Taft Hartley Funds, and United Healthcare.
Medicare pays selected practices a per-beneficiary per-month (PBPM) risk-adjusted care management fee, which ranges from $8 to $40. CMS has indicated that it expects care management fees to average $20 PBPM during the first two years of the initiative. In Years 3 and 4, care management fees will average $15 PBPM. Medicare will also introduce a shared savings component beginning in Year 2, calculated at the market level.
The CPCi solicitation for payers indicates that participating payers (non-Medicare) are expected to follow a similar framework, paying per-member per-month (PMPM) care management fees to participating practices on top of fee-for-service and incorporating a shared savings component. Payment amounts will be negotiated individually with participating practices to comply with anti-trust laws.
HealthTeamWorks Multi-payer Pilot: Participating HealthTeamWorks pilot sites received enhanced care management and performance-based payments on top of fee-for-service reimbursement.

1. Enhanced payments: Connecticut Medicaid will pay participating practices a fee differential payment in addition to the exiting fee schedule, encounter rate or visit rate a practice would normally receive.
2. Performance payments: Qualified participants will have an opportunity to earn two distinct per member per month performance-based payments: incentive payments and improvement payments. These payments may be risk-adjusted.

Incentive Payments:Practices in the top tenth percentile for performance will receive 100 percent of the possible incentive payment, and fractions of the incentive payment begin phasing in at the 25^th percentile.
Improvement Payments:Practices in the top tenth percentile for improvement will receive 100 percent of the possible improvement payment. Practices with a 5 percent improvement will receive half of the possible improvement payment, and practices with a 10 percent improvement will receive three-quarters.
Connecticut Medicaid plans to pursue alternative payment methods and intends to develop a prospective per member per month (PMPM) methodology for qualified providers by 2014.
Glide Path practices:

1. Supplemental start-up payments: Small independent practices (defined as having five or fewer full-time equivalent practitioners) whose primary care panel is at least 25 percent Medicaid recipients are eligible to receive start-up infrastructure payments ranging from $13,000 – $25,000. The state will divide start-up payments into three parts, one payment at the start of each Glide Path phase. If a practice fails to achieve NCQA recognition, it must return all supplemental payments it has received.
2. Enhanced payments: Connecticut Medicaid will pay participating Glide Path practices 50 percent of the fee differential payment paid to fully qualified practices in addition to the exiting fee schedule, encounter rate or visit rate a practice would normally receive. If a practice fails to meet Medicaid’s requirements, enhanced payments will end. However, Connecticut Medicaid will not seek reimbursement for fee differential payments already made.

• Idaho Medicaid: $15.50 (see below)
• Blue Cross of Idaho: $15.50 – $20.00. Payment amounts vary based on practices’ achievement of optional qualification standards above minimum required criteria.
• Pacific Source: $22.50
• Regence Blue Shield: $33.00 – $42.00

Participating payers limit payment to patients who qualify based on chronic conditions or medical complexity; to learn more about each payer’s criteria, visit the summary of additional requirements: Blue Cross of Idaho, Pacific Source, and Regence Blue Shield of Idaho. To learn more Idaho Medicaid, see below.
ACA Section 2703 State Plan Amendment: Medicaid is making payments of $15.50 PMPM to participating health home practices on behalf of qualifying Medicaid participants. Qualifying Medicaid participants include:

• Patients with serious and persistent mental illness or serious emotional disturbance (pediatric); or
• Patients with diabetes and asthma; or
• Patients with diabetes who have or are at risk of having another chronic condition (hypertension, high cholesterol, coronary arterial disease, obesity, or tobacco use); or
• Patients with asthma who have or are at risk of having another chronic condition (hypertension, dyslipidemia, coronary arterial disease, obesity, or tobacco use).

• $2.00 per child (under 21) per member per month (PMPM)
• $3.00 per adult
• $4.00 per senior or disabled adult

Illinois Health Connect primary care providers are also eligible for performance-based payments. In 2010 years, $3.3 million was been paid for achieving clinical targets.  For 2011 and 2012, bonuses depend on performance in the following six areas:

• Recommended immunizations
• Developmental screenings
• Asthma management
• Diabetes management
• Breast cancer screening
• Lead screening

Information on specific performance targets is available online.

• Colon and cervical cancer screenings
• Documentation of patient body mass index
• Use of culturally and linguistically appropriate educational materials
• Tracking of patients referred to the hospital
• Tracking of patient medications
• Use of disease registry
•  Documentation of tobacco use
•  Immunization administration
•  Use of HbA1c tests for diabetic patients

Further detail on the performance measures is available on pages 42-43 of the IowaCare 1115(a) waiver.
In addition to these payments, the IowaCare waiver established reimbursement for peer-to-peer provider consultation. This allows remote hospital-based specialists to receive payment for consulting with IowaCare primary care providers.  The consultations are reimbursed at fees ranging from $20.30-$44.37 depending on the length and method of consultation (telephone, e-mail, or video conference). Further details are available on pages 40-41 of the waiver.
ACA Section 2703 Health Homes: Health homes receive a complexity-adjusted per-member-per-month (PMPM) on top of fee-for-service reimbursements for patients with chronic diseases based on a Patient Tier Assessment Tool:

• Tier 1 (1-3 chronic conditions): $12.80 PMPM
• Tier 2 (4-6 chronic conditions): $25.60 PMPM
• Tier 3 (7-9 chronic conditions): $51.21 PMPM
• Tier 4 (10+ chronic conditions): $76.81 PMPM

1. Prepaid: Three managed care plans (Amerigroup Louisiana, Inc., Amerihealth Mercy of Louisiana, Inc. and Louisiana Healthcare Connections, Inc.) receive monthly risk-adjusted capitated payments. These plans also receive a lump sum maternity payment for each obstetrical delivery to cover the cost of prenatal and post-partum costs, as well as the delivery and normal newborn hospital costs. The networks are liable for 100% of any costs above the capitation rate. For more information on the reimbursement model or risk-adjustment methodology, please see the Request for Proposal.
2. Shared Savings: Two managed care plans (Community Health Solutions, Inc. and United Healthcare of Louisiana) receive per-member per-month (PMPM) enhanced primary care case management fees and, if earned, lump sum shared savings payments. For more information, please see the Request for Proposal. The networks are required to pay a portion of their case management fees to primary care providers as a PMPM care coordination payment. Up to 50 percent of the network’s case management fee is subject to repayment to the state if the predetermined savings benchmark is not met.

Both RFPs allow networks to develop performance-based physician incentive plans.

• Blood pressure measurement (also a Centers for Medicare & Medicaid Services (CMS) electronic health record (EHR) meaningful use core measure);
• Adult Weight Screening and Follow-Up (also a CMS EHR meaningful use core measure);
• Reduction in 30-day readmission rate;
• Reduction in number hospital days per 1,000; and
• Reduction in emergency room visits per 1,000.

Practices that meet the performance criteria will then be entitled to payments of 30 percent to 50 percent of any savings generated by the practice. FQHCs will be able to share in 65 percent of savings for patients with Medicaid coverage.
Savings will be calculated separately for the commercially insured, Medicaid, and Medicare Advantage populations. The calculations will entail comparing expected costs for a given practice’s population (as derived from baseline data) with actual costs for the practice population. Expected costs will be adjusted to include medical inflation. It should be noted that fixed transformation payments will be included in determining actual costs. Therefore, practices must generate savings beyond the amount of the fixed transformation payments in order to be eligible for incentive payments. (FQHCs are eligible for “first dollar” shared savings, as they are not receiving fixed transformation payments.) Provision is made for the Maryland Health Care Commission (MHCC) to adjust the incentive payment algorithm in recognition of changes in practice case mix or for outliers.
The MHCC announced in October 2012 that 23 of the 52 participating pilot practices received shared savings payments from Aetna, CareFirst BlueCross BlueShield, CIGNA, United Healthcare, and Coventry. The total incentive payments, based on 2011 performance metrics and savings, were $815,669.62.
Full details on the payment methodology are available online in the practice participation agreement.

• MassHealth Primary Care Clinician (PCC) Plan
• Health Safety Net
• Blue Cross Blue Shield of Massachusetts
• Boston Medical Center HealthNet Plan
• CeltiCare
• Fallon Community Health Plan
• Harvard Pilgrim Health Care
• Health New England
• Neighborhood Health Plan
• Network Health
• Tufts Health Plan
• Senior Whole Health
• UniCare
• The Health Connector Authority
• Group Insurance Commission (state employees)

Payers made several types of payments to support participating medical homes prior to the end of PCMHI in April 2014:

• Start-up payments to practices to support medical home infrastructure: these payments ranged up to $15,000 in the first year of the PCMHI and $3,500 in the second year.
• Ongoing payment for medical home activities: $1.50 per member per month (PMPM)
• Ongoing support for clinical care management services: $0.60 PMPM for individuals under age 18, $1.50 PMPM for individuals age 18-64, $6.00 PMPM for individuals age 65 or older
• Shared savings payments: the payers  agreed to share savings with the participating practices if they generated savings relative to a control group of practices.

Primary Care Payment Reform Initiative (PCPRI): Participating practices receive three types of payments:

1. Comprehensive Primary Care Payment (CPCP): A risk adjusted per-member per-month (PMPM) payment for primary care services which can include payment for behavioral health services as well.
2. Quality Incentive Payment: Participating practices receive incentive payments based on fulfilling PCPRI measurement and reporting requirements (“pay for reporting” or P4R); and for performance improvement and/or achieving high quality (“pay for quality performance” or P4Q). Practice performance for calendar year 2012 will serve as a baseline for P4Q.
3. Shared Savings/Shared Risk Payment: Shared savings and shared risk payments are calculated based on the difference between each participating practice’s target spend – set by the Massachusetts Executive Office of Health and Human Services (EOHHS) – and their actual spend. Participating practices can choose to include long-term services and supports in target and actual spend calculations for the purpose of calculating shared savings and shared risk. Participating practices choose one of three risk tracks on which shared savings payments will be based:
   • Risk Track 1 (Upside/Downside Risk): Practices are eligible to share in savings or losses, and will receive or owe 60% of the difference between their target spend and their actual spend, up to 6% of target spend. Risk Track 1 practices must have at least 5,000 patients enrolled in a MassHealth MCO or the Primary Care Clinician (PCC) Plan, MassHealth’s Primary Care Case Management program.
   • Risk Track 2 (Transitioning to Downside Risk): In Year 1, practices are eligible for shared savings only, using the Risk Track 3 methodology for calculating savings and distributing payments (see below). In Year 2, practices are eligible to share in savings or losses, and will receive or owe 60% of the difference between their target spend and their actual spend, up to 6% of target spend for shared savings and up to 3% of target spend for shared losses. In Year 3, practices will transition fully shared savings and risk, using the Risk Track 1 methodology. Risk Track 2 practices must have at least 5,000 patients enrolled in a MassHealth MCO or the PCC Plan.
   • Risk Track 3 (Upside Risk Only): Practices are eligible to share in up to 50% of savings. The proportion of savings paid to practices varies based on the level of savings. Practices that produce greater savings (the difference between actual spend and target spend as a percentage of target spend) are eligible for a greater share of savings. Risk Track 3 practices must have at least 3,000 patients enrolled in a MassHealth MCO or the PCC Plan.

For more information on how the state plans to calculate CPCP, quality incentive, and shared savings/shared risk payments, including target spend and actual spend, see Attachement A of the PCPRI RFA.
Practice performance on 23 quality measures that will also impact P4R (all years), P4Q (Years 2-3), and SS (Year 3 only) payments. For more information on the selected measures, including impact on payment, see Attachement D of the PCPRI RFA.

• Care coordination payment – $3.00 PMPM ($4.50 for Medicare)
• Practice transformation payment – $1.50 PMPM ($2.00 for Medicare)
• Performance incentives – $3.00 PMPM

1. State employee group insurance
2. Blue Plus (Blue Cross Blue Shield of Minnesota)
3. HealthPartners
4. Itasca Medical Care
5. Medica
6. Metropolitan Health Plan
7. Preferred One
8. Primewest Health
9. South County Health Alliance
10. UCare Minnesota

In order to receive enhanced reimbursement, practices must actively identify patients as qualifying members of their panel. According to the state plan amendment authorizing the Medicaid payment methodology, payments are tiered based on the number of “major condition groups” (i.e., cardiovascular, respiratory, neurologic, renal, etc.) within which a patient has a severe, chronic condition requiring a care team.

• Tier 1 (1-3 major condition groups): $10.14 per-member per month (PMPM) payment
• Tier 2 (4-6 major condition groups): $20.27 PMPM
• Tier 3 (7-9 major condition groups): $40.54 PMPM
• Tier 4 (10+ major condition groups): $60.81 PMPM

The monthly PMPM payment is increased by 15% if a patient’s (or patient caregiver’s) primary language is not English or if the patient (or patient caregiver) has a severe and persistent mental illness. If both of these complexity factors are present, the PMPM is increased by 30%.

• Payment for PCMH recognition/certification/accreditation;
• Reimbursement for care coordination, care management, disease management, population health, behavioral health specialist, and clinical pharmacist services;
• Payment for quality improvement;
• Shared Savings; or
• Block grants to support medical home capabilities.

Payers may adopt alternative payment methodologies that support the intent of the program subject to the Commissioner of Securities and Insurance’s approval.
Specifically, Medicaid pays an additional per-member per-month (PMPM) payment ranging from $3.33 to 15.33 depending on patient acuity. The commercial payers have taken various approaches, including new fee-for-service codes, PMPM payments, shared savings, performance-based payment, and lump-sum grants. Additional information for each payer follows: Allegiance Benefit Plan Management, Inc.; BlueCross BlueShield of Montana; PacificSource Health Plans.

• Payments must be value-based and go beyond the fee-for-service system.
• Payments should be linked to practice performance (clinical, financial, and/or patient satisfaction).
• Payments should not be limited to patients with a specific condition or set of conditions; instead, practices should be paid on behalf of their full panel of covered patients.

• Level 1: $5.50
• Level 2: $11.25
• Level 3: $16.75

Office-based practitioners:

• Level 1: $7.00
• Level 2: $14.25
• Level 3: $21.25

Medicaid discontinued payments to Level 1 NCQA PCMH providers in December 2012. The state announced in May 2013 that it would discontinue payments to practices recognized as Level 2 under the NCQA 2008 standards and reduce payment to practices recognized as Level 3 under the 2008 standards in July 2013.
Managed care plans pay a per-member per-month (PMPM) incentive payment for each participating enrollee. This payment is also tiered by NCQA recognition:

• Level 1: $2.00 PMPM
• Level 2: $4.00 PMPM
• Level 3: $6.00 PMPM

ACA Section 2703 Health Homes: Health homes receive a risk-adjusted per-member per-month care management fee that varies based on geography and case mix. Fees range from $75-$390. Health homes are paid the full PMPM rate for patients in the “active care management group” (those who are fully enrolled and have been assigned a care manager who have received at least one core health home service during the quarter), or 80% of the PMPM rate for up to six months for eligible patients in the “case finding group” (patients identified as eligible and attributed to a health home but not yet enrolled or assigned a care manager).
Comprehensive Primary Care Initiative (CPCi): This four-year multi-payer initiative, launched in November 2012, includes seven payers in New York’s Capital District-Hudson Valley market: Medicare, Aetna, Capital District Physicians’ Health Plan, Empire Blue Cross, Hudson Health Plan, MVP Health Care, and Teamsters Multi-Employer Taft Hartley Funds.
Medicare pays selected practices a per-beneficiary per-month (PBPM) risk-adjusted care management fee, which ranges from $8 to $40. CMS has indicated that it expects care management fees to average $20 PBPM during the first two years of the initiative. In Years 3 and 4, care management fees will average $15 PBPM. Medicare will also introduce a shared savings component beginning in Year 2, calculated at the market level.
The CPCi solicitation for payers indicates that participating payers (non-Medicare) are expected to follow a similar framework, paying per-member per-month (PMPM) care management fees to participating practices on top of fee-for-service and incorporating a shared savings component. Payment amounts will be negotiated individually with participating practices to comply with anti-trust laws.

• Aged, Blind and Disabled (ABD) population: $5.00 PMPM
• Non-ABD population: $2.50 PMPM

CCNC Networks receive:

• ABD population: $13.72 PMPM
• Non-ABD population: $3.72 PMPM

Networks return $3.17 and $0.54 monthly for each ABD and non-ABD enrollee to support the central office.
Prior to statewide expansion and ABD participation, CCNC networks and providers both received $2.50 PMPM for each enrollee.
Carolina Access providers not participating in the Community Care of North Carolina program receive $1.00 PMPM.
ACA Section 2703 Health Homes: North Carolina’s health homes program pays practices and networks using the same methodology as the Community Care of North Carolina program, described above.
Medicare Advanced Primary Care Practice (MAPCP)Demonstration: Payments to participating practices vary by payer:

• Medicare: $2.50-$3.50 in addition to fee-for-service. Payments vary based on level of NCQA PCMH recognition: practices with Level 1 recognition receive $2.50; Level 2 practices receive $3.00; and Level 3 practices receive $3.50.
• North Carolina Medicaid: Medicaid payments are consistent with the CCNC payment methodology, described above.
• Blue Cross Blue Shield of North Carolina (BCBSNC) and State Health Plan (administered by BCBSNC): Practices receive enhanced fee-for-service payments for Evaluation & Management codes. Enhanced payments begin when a practice submits its application for NCQA PCMH recognition.
• Participating CCNC networks in counties also receive per-member per-month payments from each participating payer. See CCNC’s MAPCP Frequently Asked Questions page for more information on how payments are made.

• Quarterly per-member “transitional” payments to support practice transformation (only available during the first year of the program);
• Traditional fee-for-service reimbursement for visits*;
• A tiered per member per month (PMPM) care management payment that ranges from $3.03 to $8.69; and
• Quarterly SoonerExcel performance-based incentive payments.

*Providers can use additional codes to bill for enhanced reimbursement when providing care outside of normal business hours.
Comprehensive Primary Care Initiative (CPCi): This four-year multi-payer initiative, launched in October 2012, includes four payers in the Tulsa market: Medicare, Oklahoma Health Care Authority, CommunityCare, Blue Cross and Blue Shield of Oklahoma.
Medicare pays selected practices a per-beneficiary per-month (PBPM) risk-adjusted care management fee, which ranges from $8 to $40. CMS has indicated that it expects care management fees to average $20 PBPM during the first two years of the initiative. In Years 3 and 4, care management fees will average $15 PBPM. Medicare will also introduce a shared savings component beginning in Year 2, calculated at the market level.
The CPCi solicitation for payers indicates that participating payers (non-Medicare) are expected to follow a similar framework, paying per-member per-month (PMPM) care management fees to participating practices on top of fee-for-service and incorporating a shared savings component. Payment amounts will be negotiated individually with participating practices to comply with anti-trust laws. Payments from the Oklahoma Health Care Authority for providers caring for Medicaid enrollees in CPCi are as for SoonerCare Choice mentioned above.

• Valuing services performed by nurses and behaviorists;
• Payment for the establishment and use of team-based care
• Preventive, educational, diagnostic care, care management and follow-up social services coordination; and
• Home visits for case management services

Chapter 590 also granted the Department of Human Services authority to develop additional incentive payments to transform the current primary care delivery system and improve the population’s health outcomes, such as:

• Integrating primary, oral and behavioral health care;
• Utilizing evidence-based best practices;
• Improving health outcomes; and/or
• Learning collaborative participation.

Oregon plans to reimburse providers for currently care coordination services that were previously non‐reimbursable. The Oregon Health Policy Board has directed the Oregon Health Authority to pursue innovative payment methodologies. Such innovative payment methodologies must:

• Provide financial support for meeting PCPCH standards;
• Recognize the three levels of PCPCH tiering; and
• Base reimbursement on the quality rather than the quantity of services provided.

If an MCO or carrier does not pursue an innovative payment arrangement, a specific additional payment is made to practices meeting PCPCH criteria. This payment corresponds to the PCPCH Tier for which a practice qualifies (Tier 3 > Tier 2 > Tier 1). When developing the payment rate, the MCO and/or carrier must consider the costs practices incur for meeting the PCPCH criteria, including, but not limited to:

• Electronic medical record implementation and upgrade;
• Care coordination; and
• Dedicated time to quality improvement.

Comprehensive Primary Care Initiative (CPCi): This four-year multi-payer initiative, launched in November 2012, includes seven payers in the Oregon market: Medicare, Oregon Health Authority, CareOregon, Providence Health Plans, Regence BlueCross BlueShield, Teamsters Multi-Employer Taft Hartley Funds, and Tuality Health Alliance.
Medicare pays selected practices a per-beneficiary per-month (PBPM) risk-adjusted care management fee, which ranges from $8 to $40. CMS has indicated that it expects care management fees to average $20 PBPM during the first two years of the initiative. In Years 3 and 4, care management fees will average $15 PBPM. Medicare will also introduce a shared savings component beginning in Year 2, calculated at the market level.
The CPCi solicitation for payers indicates that participating payers (non-Medicare) are expected to follow a similar framework, paying per-member per-month (PMPM) care management fees to participating practices on top of fee-for-service and incorporating a shared savings component. Payment amounts will be negotiated individually with participating practices to comply with anti-trust laws.

1. All practices are receiving “Physician Coordinated Care Oversight Services” PMPMs. The amounts are as follows:

• Year 1: $1.50
• Year 2: $1.28
• Year 3: $1.08

1. Practices are receiving “Coordinated Care Fees” that vary by patient age. These PMPMs are intended to provide funding for care coordinators.

• The amounts are as follows for those age 18 or younger:

Year 1: $0.60
Year 2: $0.51
Year 3: $0.43

• The amounts are as follows for those age 19-64:

Year 1: $1.50
Year 2: $1.28
Year 3: $1.08

• The amounts are as follows for those age 65-74:

Year 1: $5.00
Year 2: $4.25
Year 3: $3.61

• The amounts are as follows for those age 75 or older:

Year 1: $7.00
Year 2: $5.95
Year 3: $5.06
Practices are eligible for shared savings payments that will take into consideration practice performance on key quality metrics, including diabetes and hypertension management, as well as utilization and cost metrics. As the PMPM amounts decrease from Year 1 to Year 3, practices will be eligible for greater shares of any savings: 40% in Year 1, 45% in Year 2, and 50% in Year 3.

1. Monthly Care Coordination Fees: Networks receive monthly care coordination fees equal to $10 per member per month (PMPM).
2. Shared Savings: Networks that save money can earn shared savings payments of 50 percent of the actual savings (up to a maximum of five percent of the total fee for service payments incurred by network enrollees). The South Carolina Department of Health and Human Services calculates costs and savings quarterly.

Networks that do not achieve savings risk a penalty that would require the network to return a portion (or all) of their prospective care coordination fees.
It is up to each CSO to determine specific care coordination fees and shared savings payments made to the participating primary care providers in their network. Care coordination fees to providers are paid out of the network’s $10 PMPM payment.
Participating providers continue to receive fee for service reimbursement from South Carolina Medicaid; the Medical Home Networks do not pay any claims.

• Premera
• Regence
• Group Health
• Aetna
• CIGNA
• United Health Care
• Molina Health Care
• Community Health Plan of Washington

For the duration of the Pilot, participating practices received per member per month (PMPM) payments and were be eligible for shared savings payment if they reduce avoidable acute care utilization. The amount of the PMPM payment was set at $2.50 initially; it decreased to $2.00 PMPM after the first nine months. If practices did not achieve savings greater than or equal to the total amount of PMPM payments, they were accountable for paying back up to half of the PMPM payments through reductions in future PMPM payment rates. Further information on the payment model is available here.
Under the Patient Centered Medical Home (PCMH) Collaborative, participating practices have received stipends of $6,400 per practice to attend eight days of learning sessions.

• UniCare (Medicaid managed care)
• Highmark Blue Cross Blue Shield
• Public Employees Insurance Agency (state employees)

1. Participate in WyHealth, a care management program for Medicaid enrollees;
2. Attest to implementing core medical home functions, based on NCQA PCMH standards.
3. Pull continuity of care documents for at least half of their Medicaid patients from the state’s health information exchange on a quarterly basis, and
4. Submit nine clinical quality measures into the State Level Registry on a monthly basis.