providers; providers would still receive more on average for a Dual in integrated managed care products than in FFS $100.00 total $88.00 total total More than ≥$100.00 (Medicare $88.00, but less allowable: than $100.00 $100) Payment from One Care / SCO $20.00 $8.00 $100.00 plan with Patient Copay Medicaid Payment from Payment One Care / SCO provider pricing plan benchmark $80.00 $80.00 Medicare Medicare Payment Payment Medicare only Dual in FFS Dual in One Demo 2.0: (non-duals) Care/ SCO Dual in One Care/SCO Example Medicaid Wrap Limit in One Care/SCO: 88 -100% of Medicare allowable
providers; providers would still receive more on average for a Dual in integrated managed care products than in FFS $100.00 total (Medicare allowable: $100) $88.00 total ≥$100.00 total More than $88.00, but less than $100.00 Payment from One Care / SCO plan with provider pricing benchmark $20.00 Patient Copay $8.00 Medicaid Payment $100.00 Payment from One Care / SCO plan $80.00 Medicare Payment $80.00 Medicare Payment Medicare only (non-duals) Dual in FFS Dual in One Care/ SCO Demo 2.0: Dual in One Care/SCO Example Medicaid Wrap Limit in One Care/SCO: 88 -100% of Medicare allowable
180614-dual-demo-2.0.docx