Value-Based Care Contracts

Contract Terms

• Patient Population Demographics
• Fee Schedule vs Medicare – CPT/HCPCS Variants (i.e., AVW included?)
• Patient Population Benefits – co-payments, formularies, networks, etc.
• Patient Attribution
• Patient Notification & Authorizations
• Patient Documentation
• Quality Measures/Star Rating, Care Gaps
• Data Sharing – detailed claims, member lists, etc.
• Benchmarks/Budgets
• Shared Savings/Loss Calculations
• Performance Based Incentives
• Performance Based Payment Calculations

Joint Operating Agreement - Joint Venture

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