Alternative Provider Payment Methodologies Sample Clauses

Alternative Provider Payment Methodologies. Network Provider contracts may include incentives earned as a condition of meeting standards relating to utilization, quality of care, efficiency measures, compliance with other initiatives (such as patient-centered medical homes), or other clinical integration or practice transformation standards. An example of such alternative arrangements includes Network Provider contracts using a risk pool. The Network Provider will be paid a negotiated amount and a portion of that Health Services payment, as negotiated with Network Providers is placed at risk to be returned if certain standards are not met. As compensation for negotiating, designing and measuring standards with Network Providers, MSI will retain any amounts Network Providers are required to return to MSI for failure to meet standards. MSI anticipates that such amounts will not exceed one percent (1%) of claims. Sponsor agrees that MSI shall be entitled to retain such amounts as part of the aggregate administrative fees paid to MSI for the provision of services under this Addendum. Plan Administrator agrees and understands that the Network Provider will retain these at-risk amounts and the interest earned on such amounts will be retained by the Network Provider as part of the Health Services fee arrangement. Due to the comprehensive nature of such measures, final determination of meeting criteria may not occur until subsequent Plan years. MSI reserves the right to use different alternative payment methodologies than the risk pool method described here. In the event MSI enters into other arrangements which would result in a portion of the Health Services payments made under this Section 3 potentially not being earned by Network Providers, MSI will provide information to Plan Administrator regarding the arrangement. Only the initial Health Services payment to Network Providers will be subject to a Covered Employee or Dependent’s Copayment, Coinsurance and/or Deductible Amounts. Subsequent return of a risk pool amount, although attributable to the covered services rendered by the Network Provider during the measurement period, will generally not give rise to a second coinsurance obligation or deductible liability for, or refund to, the Covered Employee or Dependents who received the original covered services. STOP LOSS INSURANCE CONTRACT BETWEEN XXXXXX/XXXXXX COUNTY AND MEDICA INSURANCE COMPANY (“MIC”) EFFECTIVE JANUARY 1, 2017 TABLE OF CONTENTS ARTICLE 1. STOP LOSS SCHEDULE 3 ARTICLE 2. DEFINITIONS 4 AR...