Incentive Only - This level of contract commitment allows Kettering Physician Network (KPN) to participate in Quality Incentives contracted for on behalf of Kettering Health Physician Partners (KHPP), such as incentives for value that have been committed by the Kettering Health Employee Plan. This level may also include care management agreements providing a payment per member, per month for care management activities.
Commercial Fee-for-Service Contracts - KPN will allow KHPP to replace their current practice's contracts based on recommendations from the Contracting committee and decisions by the Board of Directors. At the inception of KHPP, no Commercial Fee-for-Service Contracts are as of yet in place.
Medicare Advantage Contracts - Medicare Advantage Contracts are being negotiated that will provide for distribution of a portion of any savings over the expected acuity-adjusted cost of care back to KHPP. Providers are paid at Medicare fee-for-service rates until such time that the total cost of care can be calculated and compared to the historical average for the contracted patients. KHPP plans initially to contract only for potential 'upside' shared savings distributions (no risk of repayment if the total cost of care exceeds the expected). These contracts are also expected to provide a per member, per month care management fee payable to the primary care physician for each assigned patient. A portion of the care management fees as well as distribution of any shared savings is at risk based on attainment of performance targets for selected Healthcare Effectiveness Data and Information Set measures.
Bundled Payment Agreements (by invitation only) - Bundled payment, also known as episode-based payment, case rate, global payment or package pricing, is defined as the reimbursement of health care providers, such as physicians and hospitals, on the basis of expected costs for clinically-defined episodes of care. Typically the bundled payment is set in advance, but in the case of the CMS Bundled Payment Initiative being proposed for knee and hip replacements, fee-for-service payments will be made and then reconciled against historical or market-based cost expectations with the potential of additional payment and/or requirement for pay back if the total cost exceeds the target. Bundled payment contracts will be condition-specific and KHPP physicians will be invited to participate in specific Bundled Payment Contracts as appropriate for their specialty.
Managed Medicaid Contracts - The majority of Ohio Medicaid recipients are contracted through Managed Medicaid Contracts, such as CareSource. Like Medicare Advantage Contracts, it is anticipated that in addition to fee-for-service payments at Medicaid rates, these contracts may provide for a distribution of a portion of any savings achieved if attainment of performance targets on selected quality measures is met.