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AMENDMENT NUMBER SEVEN TO THE CONTRACT BETWEEN THE DIVISION OF MEDICAID IN THE OFFICE OF THE GOVERNOR AND A CARE COORDINATION ORGANIZATION (CCO) (UnitedHealthcare of Mississippi, Inc. d/b/a UnitedHealthcare

How to fill out risk-based contracting for high-need

How to fill out risk-based contracting for high-need

1. Identify the specific population group that you want to target with the risk-based contracting for high-need.
2. Assess the specific needs and risks associated with this population group.
3. Develop a comprehensive plan for addressing these needs and mitigating the risks through the use of risk-based contracting.
4. Identify potential contracting partners who can provide the necessary services and support for the high-need population.
5. Establish clear criteria and performance measures for evaluating the success of the contract and the impact on the targeted population.
6. Negotiate and finalize the risk-based contracting agreements with the selected partners.
7. Implement the contracted services and monitor their effectiveness in meeting the identified needs and mitigating the risks.
8. Regularly evaluate the performance and outcomes of the contracting arrangements and make any necessary adjustments or improvements.
9. Continuously communicate and collaborate with the contracted partners to ensure ongoing alignment and responsiveness to the needs of the high-need population.
10. Periodically review and update the risk-based contracting arrangements to adapt to any changes in the needs or characteristics of the targeted population.

Who needs risk-based contracting for high-need?

1. Healthcare organizations and systems that serve high-need populations, such as individuals with complex medical conditions, chronic illnesses, disabilities, or social and behavioral health needs, can benefit from risk-based contracting.
2. Insurance companies and payers who are looking to improve the quality and efficiency of care for high-need populations may also need risk-based contracting.
3. Government agencies responsible for population health management and health system coordination can utilize risk-based contracting to better address the needs of high-need populations.
4. Providers and healthcare professionals who want to deliver more integrated and coordinated care for high-need individuals may find risk-based contracting helpful in supporting their efforts.

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What is risk-based contracting for high-need?

Risk-based contracting for high-need refers to agreements where healthcare providers are reimbursed based on the risk of care and the needs of patients who require more complex services, often focusing on achieving better health outcomes while controlling costs.

Who is required to file risk-based contracting for high-need?

Healthcare organizations that enter into risk-based contracts for high-need populations, including payers and providers managing care for individuals with significant health challenges, are required to file.

How to fill out risk-based contracting for high-need?

To fill out risk-based contracting for high-need, organizations must gather necessary patient data, evaluate risk levels, outline service plans, and submit required documentation through designated channels or platforms as specified by regulatory authorities.

What is the purpose of risk-based contracting for high-need?

The purpose of risk-based contracting for high-need is to incentivize providers to deliver effective care, improve patient outcomes, and manage healthcare costs by aligning financial incentives with the quality of care provided.

What information must be reported on risk-based contracting for high-need?

Reported information must include patient demographics, risk assessments, care plans, outcomes data, financial arrangements, and any performance metrics relevant to the contracted services.