Payment Alignment Sample Clauses

Payment Alignment. The parties share the objective of improving the likelihood that ACOs attain their cost and quality improvement goals by aligning payment incentives at the payer-ACO level to the individual clinician and facility level. A. The performance incentives that are incorporated into the payment arrangements between the State and the Contractor should be appropriately reflected in those that the Contractor utilizes with participating providers. Annually, no later than the third quarter of each program year, the Contractor will share with the State their written plans for: 1. Aligning provider payment and compensation with Contractor performance incentives for cost and quality; and 2. Distributing any earned shared savings. 3. Specific to affiliated providers or incentive pool forms of compensation, the Contractor will provide detailed and specific plans for funding and distribution under these programs. B. The State will support the Contractor by collaborating to align performance incentives by considering the use of alternative payment methodology including bundled payments and other episode-based payment methodologies.

Payment Alignment. Objective: Improve the likelihood that ACOs attain their cost and quality improvement goals by aligning payment incentives at the payer-ACO level to the individual clinician and facility level. 1. The performance incentives that are incorporated into the payment arrangements between a commercial insurer and an ACO should be appropriately reflected in those that the ACO utilizes with its contracted providers. ACOs will share with the GMCB their written plans for: a. aligning provider payment (from insurers or Medicaid) and compensation (from ACO participant organization) with ACO performance incentives for cost and quality, and b. distributing any earned shared savings. 2. ACOs utilizing a network model should be encouraged to create regional groupings (or “pods”) of providers under a shared savings model that would incent provider performance resulting from the delivery of services that are more directly under their control. The regional groupings or "pods" would have to be of sufficient size to reasonably calculate "earned" savings or losses. ACO provider groupings should be incentivized individually and collectively to support accountability for quality of care and cost management. 3. Insurers shall support ACOs by collaborating with ACOs to align performance incentives by considering the use of alternative payment methodology including bundled payments and other episode-based payment methodologies.