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Two years ago I attended a meeting at OHIC on this subject and there was little interest in capitation on the part of the third party payers and even less by the pediatric attendees . Could we at least address what is different today?
I'll e-mail a very contrary response to conference invitees after the end of this meeting. Look for it.
Pediatricians in RI are already the most poorly compensated pediatricians in the country. Why should we trust this model and process when the current system doesn't compensate us for what we already do?
Attribution should be in the practice control unless the insurance companies can get it reasonably right (at least 90% right which they can’t). Why? bc the practices can be more than 90% accurate in attribution. Let us define who we are seeing and then they should verify. Was is this not the current standard other than it is in the insurance companies’ interest to control attribution?
Right now the insurance companies send us list of our patients and the quality measures which we have to correct on a regular basis and send back. How will this work?
We bill 100% of our office visits. Why should we accept 65% attribution with full control of the insurers?
What about patients with PPO plans where payers require no attribution?
For implementation - will all medicaid payors have a similar outline of expectations/ services included etc?
It would generally be managed similarly to the way TCOC is attributed. Also, should generally be more frequent than annually - usually quarterly]
Because the unit of transformation is the whole practice, what portion of a typical pediatric practice needs to be under capitated care arrangements to make it work (pay for the care coordinator/IBH /community health workers etc)
Any estimate on the payment per patient for Medicaid plans in the capitated model for a healthy patient?
Can you talk about the age band question in pediatrics?
I would estimate the payment we get for a similar aged commercial payment for the previous year, that should be the base Medicaid payment plus yearly increases or at least I wouldn’t sign the contract.
Well said Beth!
What is the rollout timeline we are looking at for APM/capitation model contracts ?
100% the weekend code needs to be carved out (99050/51) or we would not agree to weekend care.
Thank you to each and every one of you for your contribution at making pediatric care the best in RI!
Thank you all for a great session!