Value-Based Purchasing Sample Clauses
The Value-Based Purchasing clause establishes that payments or compensation under the agreement are tied to the achievement of specific performance metrics or outcomes, rather than simply the volume of goods or services provided. In practice, this means that a supplier or service provider may receive higher payments for meeting or exceeding quality benchmarks, or face reduced payments if certain targets are not met. This clause incentivizes improved performance and efficiency, aiming to align the interests of both parties and ensure that value, rather than quantity, drives compensation.
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Value-Based Purchasing a. To participate in the Department’s Value Based Purchasing program which, pursuant to 42 CFR 438.6(b)(2), shall be applicable only to the rating period under this Agreement.
b. Effective January 1, 2021, the core performance measures are:
i. Adolescent well care visits
ii. Ambulatory care for SSI adults
iii. Ambulatory care for SSI children iv. Asthma medication ratio v. Breast cancer screening
Value-Based Purchasing. If multiple Contractors meet the Proximity standard, then assignment will occur based on Value-Based Purchasing (VBP) performance measures as defined by the Division (See Section 8.8, Value-Based Purchasing, of this Contract for more information), unless assignment is needed during the Special Open Enrollment described below.
Value-Based Purchasing. At its option, DOM may implement a value-based purchasing within CHIP. DOM reserves the right to phase in implementation of a value-based purchasing model beginning with a performance incentive program. Should DOM move forward with such an effort, DOM will provide operational protocols describing the process for selecting priority areas, measures, and targets, Contractor expectations, and DOM responsibilities prior to implementation. If implemented, the value-based purchasing model will require the participation of key Contractor staff, including the Medical Director, in regular meetings with DOM staff. The value-based purchasing model may lead to the creation of subcommittees to current Managed Care Program Quality Committees, referenced in Section 9.A, General Requirements, of this Contract. Contractor will have an opportunity to provide recommendations on selections for priority areas, measures, and targets based on the results of gaps analysis and root cause analyses performed by Contractor. DOM will have final authority on the selection of priority areas, measures, and targets, which Contractor will be required to comply.
Value-Based Purchasing. 6.10.1.1. Providers will be rewarded based on achieving quality and improved outcomes, rather than volume of services delivered.
6.10.1.2. The Health Plan shall develop a VBP plan that encompasses all HSD requirements, while meeting the general expectation to reward the Provider based on achieving quality and outcomes.
6.10.1.3. The VBP plan, at a minimum, shall include the following:
6.10.1.3.1. The Health Plan’s overall approach to VBP; 6.
Value-Based Purchasing. At its option, the Division may implement a value-based purchasing within the MississippiCAN Program. The Division reserves the right to phase in implementation of a value-based purchasing model beginning with a performance incentive program. Should the Division move forward with such an effort, the Division will provide operational protocols describing the process for selecting priority areas, measures, and targets, Contractor expectations, and Division responsibilities prior to implementation. If implemented, the value-based purchasing model will require the participation of key Contractor staff, including the Medical Director, in regular meetings with Division staff. The value-based purchasing model may lead to the creation of subcommittees to current MississippiCAN Program Quality Committees, referenced in Section 9.A, General Requirements, of this Contract. The Contractor will have an opportunity to provide recommendations on selections for priority areas, measures, and targets based on the results of gaps analysis and root cause analyses performed by the Contractor. The Division will have final authority on the selection of priority areas, measures, and targets, which the Contractor will be required to comply.
Value-Based Purchasing. Provider payments in VBP programs must be based upon improved Member health care outcomes and/or quality scores. The CONTRACTOR must demonstrate how VBP programs improve Member outcomes/quality scores and not solely administrative efficiencies to qualify as a VBP program. VBP Arrangements must include provisions whereby providers are held accountable to quality goals via performance measures (PMs) and savings are passed directly to the front-line providers and teams making the necessary interventions to improve quality . When selecting PMs for VBP contracts, the CONTRACTOR must adhere to any PM requirements promulgated by the Medicaid program, and the New Mexico Primary Care Council for Primary Care VBP targets. In order to be counted towards the CONTRACTOR’s total VBP Delivery System Improvement Performance Targets (DSIPT) goals, VBP arrangements applicable to Primary Care must adhere to requirements defined by the New Mexico Primary Care Council. The CONTRACTOR shall develop a VBP plan for achieving the requirements of Attachment 2, DSIPT and meeting the general expectation to reward Providers based on achieving quality and outcomes. The CONTRACTOR’s plan shall be submitted to HSD annually by April 1. Upon written approval from HSD, the CONTRACTOR shall implement its plan. The VBP plan, at a minimum, shall include the following: Initiatives, goals, targets, and strategies; Baseline period; and Data sharing arrangements established with Contract Providers under VBP arrangements. The CONTRACTOR shall submit updates to the evaluation plan to HSD quarterly that include status, supportive data, and other pertinent information to the delivery system improvement. The CONTRACTOR shall submit quarterly DSIPT reports on templates provided by HSD. The CONTRACTOR shall share performance and Claims data and lists of attributed Members with Providers on a quarterly basis for the membership that is attributed to the provider in VBP arrangements. This data should include sufficient information on all services provided to attributed Members, not just those delivered by the Contract Provider. The CONTRACTOR shall share performance and/or claims data with Providers considering entering into VBP arrangements. This data should be sufficient to allow Providers to make informed decisions about potential contracts, and, for Primary Care VBP targets, adhere to any recommendations promulgated by the New Mexico Primary Care Council. The CONTRACTOR shall provide technical assistanc...
Value-Based Purchasing