The recommended value-based incentive design used in the AMP Commercial HMO and Medi-Cal Managed Care programs is a shared savings model that relies not only on quality but also cost and resource use. While the design recommends payment based on high quality, managed cost, and appropriate resource use, each health plan determines its own budget and methodology for calculating and distributing payments to physician organizations. Additional detail about the standard incentive design can be found in the resources below.
To help California physician organizations reduce unnecessary costs, IHA developed a total cost of care (TCOC) measure to complement existing clinical quality and patient experience measures used in the AMP programs.
MY 2016 Financial Transparency Reports and MY 2017 Advanced Notice are currently being collected from health plans and will be posted here when available. Stakeholders will receive a notice when these documents are available. Financial transparency reports will show the incentive payments made by each health plan participating in AMP Commercial HMO and specify the payment methodology, adoption of the IHA common measure set, other incentive measures. and use of the aggregated results. Health plans also provide advanced notice of their intentions for payment methodologies and budget for the upcoming measurement year.