Value Based Reimbursement and Adherence to Clinical Guidelines Sample Clauses

Value Based Reimbursement and Adherence to Clinical Guidelines. If not already in place, by January 1, 2016, Contractor agrees to develop and/or implement alternative reimbursement methodologies promote adherence to clinical guidelines. Methodologies will target the highest frequency conditions and procedures as mutually agreed upon by the Exchange and Contractor. When considering the implementation of value based reimbursement programs, Contractor shall demonstrate and design approaches to payment that reduce waste and inappropriate care, while not diminishing quality.

Value Based Reimbursement and Adherence to Clinical Guidelines. If not already in place, by January 1, 2016, Contractor agrees to develop and implement alternative reimbursement methodologies focusing on the adherence to clinical guidelines. Methodologies will target the highest frequency conditions and procedures including but not limited to diabetes, asthma, heart disease, hypertension and pregnancy. The Exchange reserves the right to add alternative diagnosis and/or conditions upon reasonable notice to Contractor. When considering the development of new programs and/or pilots, Contractor will demonstrate and design approaches to payment that cut waste while not diminishing quality, including reducing unwarranted payment variation. Contractors shall pilot, evaluate and implement successful approaches to payment that automatically cut waste out of the system rather than relying on payments tied to performance measurement. These efforts will be focused in regions specifically serving the Exchange enrollees.