Upside Risk definition
Upside Risk shall be defined as the risk event applicable when CareOregon beats the target 91% Medical Loss Ratio (MLR) for Physical Health, AND the actual cost Per Member Per Month (PMPM) is less than the target cost PMPM
Upside Risk. The risk taken on by Contractor for which Contractor shall receive a portion of Shared Savings if Target Spend exceeds Actual Spend. Year 1 of the Contract Addendum (“Year 1”): The period from March 1, 2014 – December 31, 2014. Year 2 of the Contract Addendum (“Year 2”): The period from January 1, 2015 – December 31, 2015. Year 3 of the Contract Addendum (“Year 3”): The period from January 1, 2016 – December 31, 2016.
Upside Risk means that estimates are more likely to be under-estimated (conservative) than over-estimated, based on sensitivity analysis of factors that may be different from those assumed.
Examples of Upside Risk in a sentence
Notwithstanding any other provision of this Contract Addendum or the RFA, EOHHS reserves the right to require that Contractor switch from Risk Track 1 or Risk Track 2 to Risk Track 3 (Upside Risk Only) in the event that either (1) Contractor fails to obtain a risk certificate or waiver from DOI, as applicable and consistent with the provisions of Section 2.7.A of the RFA; or (2) otherwise appears not ready to take on risk under this Contract Addendum, in the sole discretion of EOHHS.
The total Provider Upside Risk Share value is additionally adjusted by the following: • Beginning with the second calendar year of this Agreement, up to half (50%) of this amount is subject to meeting quality goal targets or a portion thereof.