3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Coronary Artery Multi, Multi, 50 words. Percent. Percent. 6 Disease Checkboxes. Checkboxes. N/A OK. N/A OK. 1: Individual 1: Primary care, From 0 to 100. From 0 to 100. Physician, 2: Specialty 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Heart Failure Multi, Multi, 50 words. Percent. Percent. 7 Checkboxes. Checkboxes. N/A OK. N/A OK. 1: Individual 1: Primary care, From 0 to 100. From 0 to 100. Physician, 2: Specialty 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Oncology Multi, Multi, 50 words. Percent. Percent. 8 Checkboxes. Checkboxes. N/A OK. N/A OK. 1: Individual 1: Primary care, From 0 to 100. From 0 to 100. Physician, 2: Specialty 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above
3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Coronary Artery Disease Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 6 Heart Failure Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 7 Oncology Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 8
Qualified%20Health%20Plan%20Certification%20Application%20Fourth%20Quarter%202017%20Smal....docx