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Provider Incentives during COVID-19: You Won't Earn Less and You Can Earn More

Date: 10/29/20

COVID-19 is challenging every sector of our society, and health care providers are no exception. We believe that your practice should not be financially penalized due to the pandemic.

To help sustain providers during this challenging time, we are guaranteeing your quality incentive payments for the rest of 2020.

  • Guaranteeing Your Baseline. Your incentive payment baseline will be based on your historic performance, before the impact of COVID-19. You will not earn less than this amount. This ensures your payments do not go down due to COVID-19.

  • Preserving the Opportunity for More. Your baseline is guaranteed, and you still have the opportunity to earn higher incentive payments. You can still earn more than the baseline if additional quality measures are exceeded.

What it comes down to is this: you won’t earn less and you can earn more.

What incentive programs are included?

The monthly PMPM incentive for primary care, OB incentives, and shared savings programs are all being administered based on this “you won’t earn less and you can earn more” system for 2020.

How will payments be calculated?

Provider incentive payments are calculated based on your specific performance history. This ensures your payments do not go down compared to your 2019 payments.

  • Primary Care PMPM Incentive: The payout will be the greater of (a) your actual performance-based earnings OR (b) the incentive payment for February 2020 (pre-COVID-19).

  • OB Care Incentive: The payout will be the greater of (a) your actual performance-based earnings OR (b) the average incentive payment from September 2019 – February 2020 (pre-COVID-19).

  • Shared Savings: Quality threshold requirements have been removed from this program for 2020 dates of service, and case-by-case adjustments have been made in consultation with effected providers, depending on the specific model. Details are discussed in Joint-Operating Committee meetings between the provider and Louisiana Healthcare Connections.

Again, this system establishes your baseline payment. If your actual quality metrics are better, you will still earn a larger incentive payment. You won’t earn less and you can earn more.

What will happen to provider incentives in 2021? How will targets be reestablished?

It’s natural to want to know when provider incentive programs will return, how that transition will occur and what the resumed targets will be. There is still a lot of uncertainty about the future, and the answers to these questions have not been decided yet.

Be assured that we are continuing to closely monitor how COVID-19 is impacting members and providers, and are coordinating closely with the Louisiana Department of Health.

We understand the importance of quality incentives for your practice’s sustainability, and are committed to the success of providers in our network. When more information about when and how quality programs can be resumed, we will communicate with you as soon as we can.

What if I have questions?

If you have any questions about your provider incentive guarantee, please contact your dedicated Provider Consultant, or call us at 1-866-595-8133.

We hope this guaranteed payment will provide some financial predictability for your practice during this unpredictable year. Thank you for the care you provide to our members, your patients.