Value-Based Incentive Programs

When warranted and deemed to be a fit by the employer, we offer programs that jointly incent the providers to “do the right thing” while incenting the participants to engage and comply with the provider’s recommendations. Under these particular program strategies, providers must follow evidence-based guidelines and must further “prescribe” education to the participant whereby the participant is tested on their knowledge of the program they are to adhere to. The participant rates the provider based on their adherence to the guidelines provided to the patient at the point of service, and based on the time spent educating the patient. The physician is reimbursed at a higher level when they comply and the participant receives a reimbursement of a portion of their copay when they comply with the provider recommendations. These programs are never a “one size fits all,” and must be tailored to suit the specific utilization needs, priorities and culture of the organization.

Other value-based incentive programs include waivers or reductions of copays for compliance with certain evidence-based guidelines for chronic conditions where compliance is critical. Every strategy is unique to the needs of the specific client and its population, but all incorporate a very strategic approach to behavioral management.