Shared Savings Distribution Model
PCCN has negotiated a series of quality and financial performance measures that its payers monitor and track as a gauge of how the network is lowering costs and improving the quality of care. The metrics within these contracts are typically focused on cutting costs by preventing the duplicative tests/procedures and the administration of preventative services. In an effort to meet or exceed those metrics, PCCN has developed infrastructure and operational processes to support those targets. When the network performs well against those quality and financial measures, this performance also directly lowers the amount of medical spend. This decrease in spend is considered “savings” by the payer. When the payer confirms that the network has met its contracted measure targets and the network exhibits those “savings,” the payer creates a pool of incentive dollars that is provided to PCCN called “shared savings”. When that funding is received by PCCN, the network takes those incentive dollars and distributes them to its participating practices. You will find the description on how PCCN distributes these shared savings back to its providers below.
PCCN categorizes its providers who are “incentive eligible” into two groups: Primary Care and Specialist. PCCN has created separate and distinct payout methodologies for physician groups that have been categorized as one of these categories.
Providers designated as primary care providers will receive payout based off of the attributed population that the health plan communicates to PCCN. Primary care providers with more patients attributed to them will receive a higher payout amount than those who have a smaller attributed population. This methodology ensures that primary care providers are receiving shared savings payouts that are equitable and based off of their membership with the plan.
Providers designated as specialty providers receive a payout based off of the amount of time that they we’re credentialed under the plan during the contract period and how they performed in their access to care survey. PCCN deployed an Access to Care survey to all PCCN primary care pediatricians that assesses the availability of appointments within the specialties listed below for both urgent and non-emergent appointments. As a specialist provider, you are eligible to receive anywhere from 0 (lowest) to 2 (highest) Access to Care points. Groups who scored in the top 25 percentile receive 2 points and their full eligible incentive amount, specialties who scored in the 26th-50th percentile receive 1 point which equates to 75% of their eligible incentive amount, and specialties who scored in the bottom 50 percentile receive 0 points which equates to 50% of their eligible incentive amount.
PCCN understands the complexities of scheduling in highly specialized clinics and, with that in mind, created a way to offer groups who did not receive full points an opportunity to receive additional points based off of their year over year improvements. Specialties who exhibited a >4% growth (but <7.99%) in their access to care results were awarded an additional bonus point, and specialties who performed >8% better than the previous year received a full 2 points.
You can view the 2014 vs 2015 specialty access to care performance below:
If you have any additional questions, please contact PCCN at 602-933-7226 or PCCN@PhoenixChildrens.com.