home practices (e.g., intensive self management support to patients, action Contractor development, arrangement for social support follow-up with a social worker or other community support personnel), 11: Patient experience, 12: Health IT adoption or use, 13: Financial results, 14: Utilization results, 15: Pharmacy management, 16: Other - (provide details in next column), 17: Most Dominant measure used - (note in detail box in cell) Does the program have an Multi, Checkboxes. 200 words. 19 attribution model for assigning 1: No, 2: Yes patients to providers? If yes, please describe in second column Indicate the type(s) of benefit Multi, Checkboxes. 65 words. 20 1: Mandatory use of Centers of and/or provider network Excellence (COE) or higher features that create member performing providers, incentives or disincentives to 2: Financial incentives (lower support the payment reform premium, waived/lower co-pays) for program. members to use COE/higher performance providers, 3: Financial disincentives for members to use non-COE or lower performing providers (e.g., higher etc.), 4: Use of tiered networks, 5: Use of narrow networks, 6: Reference pricing, 7: High deductible health plans, 8: Value-based insurance design, 9: Incentives to select lower cost sites of care (e.g. worksite clinic, retail clinic, telehealth, ambulatory surgery centers), 10: Preauthorization (e.g. "gatekeeper"), 11: Precertification (e.g. health plan approval), 12: Continued stay review, 13: Step therapy, 14: Objective information (e.g., performance measure results) provided on COEs to members, providing evidence of higher-quality care rendered by these providers, 15: Other (please describe) For this payment reform program, Multi, Checkboxes. 50 words. 21 do you make information 1: We report to the general public,
home practices (e.g., intensive self management support to patients, action Contractor development, arrangement for social support follow-up with a social worker or other community support personnel), 11: Patient experience, 12: Health IT adoption or use, 13: Financial results, 14: Utilization results, 15: Pharmacy management, 16: Other - (provide details in next column), 17: Most Dominant measure used - (note in detail box in cell) Does the program have an attribution model for assigning patients to providers? If yes, please describe in second column Multi, Checkboxes. 1: No, 2: Yes 200 words. 19 Indicate the type(s) of benefit and/or provider network features that create member incentives or disincentives to support the payment reform program. Multi, Checkboxes. 1: Mandatory use of Centers of Excellence (COE) or higher performing providers, 2: Financial incentives (lower premium, waived/lower co-pays) for members to use COE/higher performance providers, 3: Financial disincentives for members to use non-COE or lower performing providers (e.g., higher etc.), 4: Use of tiered networks, 5: Use of narrow networks, 6: Reference pricing, 7: High deductible health plans, 8: Value-based insurance design, 9: Incentives to select lower cost sites of care (e.g. worksite clinic, retail clinic, telehealth, ambulatory surgery centers), 10: Preauthorization (e.g. "gatekeeper"), 11: Precertification (e.g. health plan approval), 12: Continued stay review, 13: Step therapy, 14: Objective information (e.g., performance measure results) provided on COEs to members, providing evidence of higher-quality care rendered by these providers, 15: Other (please describe) 65 words. 20 For this payment reform program, do you make information Multi, Checkboxes. 1: We report to the general public, 50 words. 21
Qualified%20Health%20Plan%20Certification%20Application%20Fourth%20Quarter%202017%20Smal....docx