Integrated Healthcare Models. Article 4, Section 4.03 5% of total performance penalty at risk Expectation: Contractor reports enrollment in integrated healthcare models, based on definition in Attachment 7, Article 4, Section 4.03 in Application for Certification for 2019. Target percentage of members who select or are attributed to IHMs will be established by Covered California for 2019 with annual intermediate milestones after baselines are reported in the Application for Certification for 2017. Performance Levels Contractor does not meet target for percent of Exchange membership attributed to integrated healthcare models.: 5% penalty Contractor achieves targeted percent of Exchange membership in integrated care models.: No penalty Contractor exceeds target increase of Covered California members in integrated care models,: 5% credit
Integrated Healthcare Models. Attachment 7, Article 4, Section 4.03 – 5% of total performance penalty for Group 3 Contractor increases Exchange enrollment in integrated healthcare models. Baseline identified from data reported in Measurement Year 2017 and 2018. Data from Measurement Year 2019 providing the percentage of Exchange membership in integrated healthcare models will be compared to baseline reported. This performance standard is not applicable to issuers with fully integrated systems where 100% of their membership is attributed or assigned to IHMs for both the baseline measurement year and the performance measurement year. Performance Requirements Measurement Year 2017 No Assessment for Plan Year 2017 Measurement Year 2018 No Assessment for Plan Year 2018 Measurement Year 2019 Expectation: Contractor increases the percentage of enrollment in IHMs by the end of 2019. Performance Levels: Contractor reports no increase in the percentage of membership attributed or assigned to IHMs: 5% penalty Contractor reports an increase of more than 0% but less than 10% in membership attributed or assigned to IHMs: No penalty Contractor reports an increase of 10% or more in membership attributed or assigned to IHMs: 5% credit Quality, Network Management and Delivery System Standards 45% of Total Performance Penalty or Credit1 for Measurement Year 2019 and Thereafter Covered California and Contractor shall work together to periodically review and adjust the specific measures consistent with any applicable Federal regulations. For Performance Standards 3.4a, 3.4b, 3.8, and 3.9, mutually agreed upon performance goals will be pre-determined and documented in Contractor’s Quality Improvement Strategy prior to the start of the performance year. Performance Standard
Integrated Healthcare Models. Article 4, Section 4.03 5% of total performance penalty for this Xxxxx.xx risk Expectation: Contractor reports Exchange enrollment in integrated healthcare models, based on definition in Attachment 7, Article 4, Section 4.03 in Application for Certification for 2019. Target percentage of Exchange members who select or are attributed to IHMs will be established by the Exchange for 2019 with annual intermediate milestones after baselines are reported in the Application for Certification for 2017. Performance Levels Contractor does not meet target for percent of Exchange membership attributed to integrated healthcare models: 5% penalty Contractor achieves targeted percent of Exchange membership in integrated care models: No penalty Contractor exceeds target increase of Exchange members in integrated care models: 5% credit
