RISK MODEL Sample Clauses
RISK MODEL. The 2025 Risk model agreed upon by Health Plan, various primary care providers of St. ▇▇▇▇▇▇▇ Medical Group, Mosaic Medical Group, Praxis Medical Group, COIPA, and the Central Oregon Community Mental Health Programs (“CMHP(s)”) shall contain the following:
(A) A construct involving two (2) main Coordinated Care Organization (CCO) territories (Central Oregon CCO and Columbia Gorge CCO) and settlements within each CCO for OHP Members, as well as the potential for settlement impacts for CMHPs should CMHPs provide services to OHP Members from the ▇▇▇▇, ▇▇▇▇▇▇/▇▇▇▇, or Portland area CCOs. In the Central Oregon CCO, the separate Health Care Budget (HCB) settlements shall be for those OHP Members who are assigned to primary care providers of (i) St. ▇▇▇▇▇▇▇ Medical Group (SCMG) combined with the primary care providers of Mosaic Medical Group (Mosaic), (ii) COIPA, and (iii) Praxis Medical Group. In the Central Oregon CCO, there are some OHP Members who are assigned to primary care providers other than SCMG, Mosaic Medical Group, COIPA, and Praxis, for whom there may be no HCB, and/or no settlement involving CMHPs.
(B) A Hospital Capitation Payment to St. ▇▇▇▇▇▇▇ Health System (SCHS) for certain hospital services in the Central Oregon CCO as a component of the separate HCBs, and for which there is a Hospital Capitation Withhold (HCW) which shall be settled for SCMG/Mosaic and SCHS.
(C) Capitated payment for primary care providers of SCMG, Mosaic, COIPA, and Praxis Medical Group for certain primary care services provided to any assigned OHP Members from any CCO, for which there will be no withhold and no independent settlement.
(D) Fee-for-service payment for all other professional services provided by SCMG, Mosaic, COIPA, and Praxis Medical Group for any CCO members not designated as capitated primary care services per (C) above.
(E) Capitated and fee-for-service payment to the CMHPs for services provided as detailed in Attachment H. Fee-for-service payments shall have a Claims Risk Withhold.
(F) Patient-Centered Primary Care Home (PCPCH) and Behavioral Health Integration (BHI) per member per month payments for which primary care providers may qualify.
(G) Payment allocations for (B), (C), (D), (E), and (F) above, and separate HCB settlements for health care expenses to determine Claims Risk Withhold and Surplus returns for SCMG, Mosaic, COIPA, Praxis Medical Group, other providers, Community Mental Health Programs (CMHPs) and Health Plan.
(H) Separate risk models ...
RISK MODEL the credit risk assessment model used by the Organizer and developed, statistics, data processing algorithms and other tools (specialist assessment, telephone conversation, SMS message, e-mail) by which the Organizer seeks to intelligently assess credit risk and on the basis of which the Organizer selects Applications and submit them to the Auction;
RISK MODEL. 5.3.1 Risk Analysis The CONSULTANT will incorporate data obtained during the field reconnaissance, desktop and field assessments, and field inspections as well as other assessment data into the risk model. As examples: Assessment or Inspection Source Risk Factor Black & ▇▇▇▇▇▇ LOF 5 – Safety Factor LOF 10 – Potential for 3rd party damage due to Pipe Depth LOF 11 – Potential for 3rd Party Damage due to Pipe Location COF 6 – Traffic Disruption COF 7 – Proximity to Commercial or Business Areas COF 11 – Difficulty of Repair ▇▇▇▇▇ Engineering LOF 2 – Compliance with Current AWWA Design Standards LOF 8 – Installation Defects ▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇ DBA DNV GL COF 4 – Population Impact COF 5 – Impact to Desired Level of Service KLR Planning COF 3 – Proximity to Sensitive Areas Allied Geotechnical ▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇ – Soil Type LOF 14 – Faulting LOF 15 – Geotechnical/Geologic Hazards ▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇ – Soil ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇ – Cathodic Protection Performance ▇▇▇▇▇▇▇ Construction COF 1 – Direct Costs of Pipe Repair ▇▇▇▇▇ LDS1000TM Video ▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇ – Lining Condition LOF 7 – Joint Condition The CONSULTANT will configure Black & ▇▇▇▇▇▇’▇ custom Asset Prioritization Tool to be used for this project. This is a custom .NET Add-In file for ArcGIS (v10.1 and higher) and does not require additional licensing. Used to streamline the risk analysis process, the Asset Prioritization Tool assists in determining the most appropriate criteria and weighting factors by enabling the user to save weighting factor scenarios, view risk matrix results, zoom to map location, and export results to Excel. This tool allows the CONSULTANT to package-up the results of the Risk Analysis and enables the City to update this Risk Analysis in- house, as the City’s needs evolve over time. The CONSULTANT will conduct a sensitivity analysis and adjust LOF and COF weighting factors, as necessary, in order for the risk model to produce accurate, repeatable, and defendable results.