Share Contractor Share. Gain up to $100,000 for the High Cost Drug Add- On to the Risk Adjusted Capitation Rate payment 99% 1% Gain of more than $100,000 for the High Cost Drug Add-On to the Risk Adjusted Capitation Rate payment 100% 0%
Share Contractor Share. Loss up to $100,000 99% 1% Loss of more than $100,000 100% 0% A BA Services Risk Sharing Arrangement (Section 4.5.E)
Share Contractor Share. Between 0 and 1.5% 0% 100% >1.5% 100% 0%
Share Contractor Share. Absolute value of savings less than or equal to 2% of the TCOC Benchmark 0% 100% Absolute value of savings greater than 2% of the TCOC benchmark 95% 5%
Share Contractor Share. Gain up to $100,000 for the High Cost Drug Add- On to the Risk Adjusted Capitation Rate payment 99% 1% Gain of more than $100,000 for the High Cost Drug Add-On to the Risk Adjusted Capitation Rate payment 100% 0% Atrius Health, Inc. in Partnership with Fallon Health
Share Contractor Share. Absolute value of savings less than or equal to 5% of the TCOC Benchmark 0% 100% Absolute value of savings greater than 5% of the TCOC Benchmark 95% 5% Absolute value of losses with an absolute value less than or equal to 5% of TCOC Benchmark 0% 100% Absolute value of losses with an absolute value greater than 5% of the TCOC Benchmark 95% 5% Risk Track 2 – Shared Accountability If the Contractor selects Risk Track 2 – Shared Accountability as set forth in in Section 4.5, the Contractor’s Shared Savings payment or Shared Losses payment shall be as follows:
Share Contractor Share. Loss up to $100,000 99% 1% Loss of more than $100,000 100% 0%
Share Contractor Share. Loss less than or equal to 2% of the Non- HCV High Cost Drug Component of the Risk Adjusted Capitation Rate payment 0% 100% Loss of more than 2% of the Non-HCV High Cost Drug Component of the Risk Adjusted Capitation Rate payment 100% 0%
Share Contractor Share. Between 0 and 2% 0% 100% >2% 100% 0% The amount of the Gain on the aggregate Medical Services Capitation Rates for the Contract shall be defined as the difference between the Total Medical Services Capitation Payment and the Contractor’s Total Expenditures for Covered Services, if such actual expenditures are less than the Total Medical Services Capitation Payment for the CY18B. EOHHS and the Contractor shall share such gain in accordance with the table below. Between 0 and $100,000 99% 1% >$100,000 100% 0% The amount of the Loss on the Capitation Rates for the Contract shall be defined as the difference between the Total Medical Services Capitation Payment and the Contractor’s Total Expenditures for Covered Services, if such actual expenditures are greater than the Total Medical Services Capitation Payment for the CY18B. EOHHS and the Contractor shall share such loss in accordance with the table below. Between 0 and $100,000 99% 1% >$100,000 100% 0% The Contractor and EOHHS shall share risk for CBHI, ABA and SUD Services in accordance with the following provisions: For Contract Year 2018, EOHHS shall conduct separate reconciliations with respect to CBHI, ABA and SUD Services, as follows: EOHHS will first determine the amount paid to the Contractor by EOHHS for CBHI, ABA and SUD Services for Contract Year 2018, by multiplying the following: The CBHI, ABA and SUD Add-On rates determined by EOHHS and provided to the Contactor in Section 1.A above; by The number of applicable member months for the period. For purposes of the 2018 reconciliations, ABA and CBHI Services are effective January 1, 2018, and SUD Services are effective March 1, 2018. EOHHS will then determine the Contractor’s expenditures for CBHI, ABA and SUD Services for Contract Year 2018, using claims data submitted in the report described in Section D.2 below and Encounter Data submitted by the Contractor. If the amount paid to the Contractor, as determined by the calculation described in Section C.1.a above, is greater than the Contractor’s expenditures, as determined by the calculation described in Section C.1.b above, then the Contractor shall be considered to have experienced a gain with respect to CBHI, ABA and SUD Services for Contract Year 2018. EOHHS and the Contractor shall share such gain in accordance with the table below for CBHI, ABA, and SUD services: Between $0 and $100,000 99% 1% > $100,000 100% 0% If the amount paid to the Contractor, as determined by the calculation described ...
