Common use of Provider Incentives Clause in Contracts

Provider Incentives. The MCO must develop and submit to HHSC a written plan using a form provided by HHSC, for expansion of alternative payment structures with its Providers that encourages innovation and collaboration, as well as increase quality and efficiency. Payment structures should be focused on incentivizing quality outcomes, shared savings, or both resulting from reducing inappropriate utilization of services, including inappropriate admissions and readmissions rather than based on volume. The plan will include mechanisms by which the MCO will provide incentive payments to hospitals, physicians and other health care providers for quality care. The plan will include quality metrics required for incentives, recruitment strategies of providers, and a proposed structure for incentive payments, shared savings, or both. The MCO must submit its initial plan to HHSC no later than December 1, 2013, and no later than December 1 of each year thereafter. HHSC will evaluate the plan and provide feedback to the MCO. Upon HHSC's approval of the plan, HHSC will retrospectively evaluate the MCO on its execution of the written plan. Modifications can be made to the plan, but are subject to HHSC review and approval. Plan approval is based on the following criteria: the number of providers, diversity of selected providers, geographic representation, and the methodology of the shared savings, data sharing strategy with providers, and other factors. Each year, the annual plan must show a measurable increase from the previous year. HHSC's retrospective review of the execution of the plan may include a review of encounter data, MCO financial statistical reports, and surveys or interviews with MCO representatives or providers. HHSC may ask the MCO to submit additional information upon request. HHSC may delay or reduce payments to the MCO if it does not submit a plan by the required deadline or does not execute a plan as approved.