Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. Rewarding Provider Performance.

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Presentation transcript:

Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. Rewarding Provider Performance Aligning Incentives in Medicare Sam Ho, M.D. CMO, Pacific & Southwest Regions

Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. 2 Implications for Health Plans Standardized Measures Transparency Incentives / disincentives High-performance networks

Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. 3 Standardized Measures Evidence-based CMS AHRQ / NQF AQA HQA BTE ABIM MOC MDs, MG/IPAs, Hospitals

Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. 4 Transparency Quality National comparison, by specialty Preventive Health Chronic Diseases Primary Care (3) Specialty Care (18) Efficiency Local comparison, by specialty Episode groups Risk-adjustment Total costs of care Resource utilization Unit costs Coordination of Care?

Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. 5 Incentives / Disincentives Direct incentives Rational value = Q&E (budget neutrality) Market share P4P Performance-based contracting Indirect incentives Administrative simplicity

Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. 6 Performance-based Contracting Model Reimbursement Fee Schedule Increases

Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. 7 High-Performance Networks Premium (value) designation Differential benefits Preferential marketing

Confidential property of UnitedHealthcare. Do not distribute or reproduce without the express permission of UnitedHealthcare. 8 Thank you.