Click here for a message for providers and agencies from the director of Gold Choice.
Unlike
other incentive plans that have a performance based pay plan,
the focus of Gold Choice is on Quality Assurance activities
which indirectly benefits the member in that we can better
measure the care they are receiving.
This model
does not force providers to compromise the care they give
our members as it is a quality versus clinical outcomes basedmeasurement.
The overall
goal of an incentive plan is:
- to
reward providers for the outstanding care you provide for
our members who, due to the nature of the program, can be
more time consuming, less compliant, and overall more challenging
than the general population, and
- to
encourage a seamless system of care by improving the quality
assurance activities that providers are required to participate
in anyway
Financial
rewards and potential earnings are based on panel size (number
of providers at each site) and number of members assigned
to each
site. The
2008 budget is funded through the administrative fee charged
to providers. Because we have been notified by the New York
State Department of Health Bureau of
Managed Care financing
that the current Medicaid capitation rates for Gold Choice
will be extended through June 30, 2009, and we have not been
able to give providers a cap increase for 7 years, we wish
to offer rewards to providers who serve our membership.
Providers
will be paid at the site level (to agent with whom the agreement
is with) for quality assurance activities and targets as described
in this guide. No specific payment will be made that is an
inducement to reduce or limit medically necessary services
furnished to Gold Choice member. This incentive arrangement
means any payment under which a contractor may receive additional
funds over and above the capitation rates they are paid.
All providers
are eligible to participate and eligibility for incentive
rewards is tied to specific membership based on PCP assignment,
number of providers at a given site, and standards of care
as outlined in the Gold Choice QAP.
Providers
are reimbursed quarterly separate from monthly capitation
payment. A report of which indicators were measured and how
the amount was tallied will be included. Criteria based assessment
is ongoing i.e. points are recorded as they are received in
an Access Database. The dollar amount each provider receives
is based on number of patients served and compliance with
guidelines and criteria.
