Current Duals Demo 2.0 Proposal One Care SCO One Care SCO Medicare Advantage Not Achieved Achieved Achieved bidding Achieved Medicare Stars quality Achieved payment methodology Not with Achieved Achieved Achieved modified Stars Two sided risk Not Achieved Achieved Achieved corridor Achieved Blended Medicare Partially Partially Achieved Achieved Medicaid MLR Achieved Achieved Zero member cost Achieved Achieved Achieved Achieved sharing Contingent upon CMS approval Slide 17 Illustrative example of potential limits on Medicaid wrap payments in One Care and SCO: Hospitals ILLUSTRATIVE EXAMPLE Non-Dual (Medicare Dual Member (Medicare + Medicaid) Provider Only) Provider Payments Payments In FFS, One Care and Limits on the providers SCO plans have Medicaid wrap receive less historically paid portion of than the total providers the provider Medicare full Medicare payments in
Proposal Current Duals Demo 2.0 One Care SCO One Care SCO Medicare Advantage bidding Not Achieved Achieved Achieved Achieved Medicare Stars quality payment methodology Not Achieved Achieved Achieved with modified Stars Achieved Two sided risk corridor Achieved Not Achieved Achieved Achieved Blended Medicare Medicaid MLR Partially Achieved Partially Achieved Achieved Achieved Zero member cost sharing Achieved Achieved Achieved Achieved Contingent upon CMS approval Slide 17 Illustrative example of potential limits on Medicaid wrap payments in One Care and SCO: Hospitals ILLUSTRATIVE EXAMPLE Non-Dual (Medicare Only) Provider Payments Dual Member (Medicare + Medicaid) Provider Payments In FFS, providers receive less than the total Medicare One Care and SCO plans have historically paid providers the full Medicare Limits on the Medicaid wrap portion of provider payments in