Assisted and recruited physician practices to participate in the Advanced-Practice Medical Payment Model (A-PMPM) pilot program with health plan, HealthyCT.

Challenge:

New health plans that have been developed as a result of the Affordable Care Act need to develop a robust and comprehensive physician network based on quality standards to attract customers and remain viable in the marketplace.

Solution:

Qualidigm initially recruited thirteen internal medicine, family practice, and pediatric physician practices to participate in the Advanced-Practice Medical Payment Model (A-PMPM) pilot program with a growing health plan, HealthyCT. This program identified measurable key transformational changes that are most beneficial to members/patients and provided financial rewards to those practices able to focus the advanced primary care model on the needs of their higher risk patients.  Based on the pilot, Qualidigm assisted the health plan in conducting a second round of physician and practice administrator advisory panel meetings to review and discuss new metrics as the health plan moves forward.

Benefit:

Qualidigm assisted Healthy CT with building a comprehensive advanced primary care network targeting 35% to 40% of the physicians in Connecticut.