CTC-RI common contract has provided Adult Performance Year 1 and 2 practices with PMPM incentive payments based upon the prior year’s performance. This has been a complicated issue as data from previous year has used to set prospective rates and this prior year data doesn’t accurately reflect current performance in the contract year. The Board of Directors has approved a change in the incentive payment process.
Health plans will be communicating with primary care practices in Transition Year and Performance Year 1 and execute an amendment to the current developmental contract, as of 07/01/2016. These amendments will be executed prior to 06/30/2017 with the following modifications:
Sites currently in the Advanced Collaborative and Performance Year 2 will remain in their current agreement, through 12/31/2016.
Sites currently in Performance Year 1 will be continued to be paid base PMPM and incentives earned according to the 07/01/2016 contract adjudication, through 06/30/17. Starting 07/01/2017, as they enter Performance year 2, these sites will only be paid the base PMPM for the 07/01/2017-06/30/2018 contract year. At the end of said contract year contracts will be adjudicated, based upon data from the Performance Year 2 year. Any performance incentives earned will then be paid out in a lump sum, for 12 months’ worth of the appropriate PMPM value, based upon the most up to date attribution.
Sites currently in Transition Year will be paid the base PMPM, as they enter Performance Year 1 on 07/01/2017 and throughout the contract year. At the end of the Performance Year 1 contract year they will be paid performance incentives in a lump sum, for 12 months’ worth of the appropriate PMPM value, based upon the most up to date attribution. As these sites move into the Performance Year 2 contract year, they will again be paid the base PMPM for the contract year. At the end of Performance Year 2, based upon the annual contract adjudication, they will be paid performance incentives, in a lump sum, for 12 months’ worth of the appropriate PMPM value, based upon the most up to date attribution.
Future expansions will receive performance incentives at the end of each performance year, in line with this policy.