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Participation options

As a provider, you have flexibility in how you transition to BlueAlliance. A three-level payment structure allows for varying stages of engagement and payment programs:

LEVEL 1

Patient-Centered Medical Home (PCMH)
Encourages a PCMH structure that can evolve to a population health model, aimed at affecting health outcomes of specific groups. Includes care management fees for meeting specific population health quality metrics.

LEVEL 2

PCMH + Shared Savings
Actual patient care costs are compared to budgeted costs. When actual costs are less than budgeted, providers share in the savings by receiving a percentage of the difference, based on quality outcomes. As with all levels, PCMH is the basis of this model.

LEVEL 3

PCMH + Risk Sharing
In exchange for sharing the risk, providers can earn higher rewards. As with level two, actual patient care costs are compared to budgeted costs. With PCMH as the base, providers are incentivized to hit quality and cost targets but risk a portion of their incentive if targets are not met.

Why PCMH?

The PCMH care model depends on primary care to both proactively direct patients toward prevention and well-being and to holistically manage chronic disease.

Coordinating that kind of care is critical to patient success, but takes time. These activities are supported by care management fees.