FAQs for Physicians
Accountable care describes a shift in how care is provided and paid for, with providers being increasingly accountable for the quality and cost of care, as well as the clinical outcomes of patients. One of the most fundamental shifts already underway is the trend toward “value-based” arrangements in which providers receive a financial incentive for achieving quality and cost targets.
Clinical integration is an ongoing program for improving coordination between health care providers across the network – primary care providers, specialists, hospitals and others – for the purpose of constant improvement in quality and to control health care costs. Some features of clinical integration include shared clinical protocols, incentives based on quality performance, and a technology infrastructure aimed at improving quality and lowering costs.
When AHP performs under budget and hits quality targets for a given contract, the difference between what was budgeted and what was actually spent is the “gain.”
For example, if it was expected to cost $100 million to care for a defined population in one year, but the healthcare expenses that year were only $85 million, the $15 million difference is the gain. If AHP hit the quality targets established under the contract, that $15 million would be shared between AHP and insurance payer. In turn, AHP would share its portion with the providers belonging to the network.
Participating in AHP’s clinically integrated network allows providers to participate in physician-friendly value-based contracts. AHP has contracts with many major insurance payers in the region covering most lines of business: commercial, managed Medicaid and Medicare Advantage. AHP also has a proven track record of earning significant gain sharing under its contracts which has in turn been shared with network physicians and hospitals.
Additionally, AHP membership for primary care physicians will mean access to financial incentives based on clinical integration activities, quality, and patient attribution. For specialists, membership preserves and builds relationships with referring providers across the network. AHP’s contracts with self-insured employers benefits all providers as patients covered by these plans will seek out AHP providers in order to take advantage of their health plan’s financial incentives.
With over 1,900 providers in our network covering most subspecialties and eight participating hospitals, there is little reason for AHP providers to refer out of network. Keeping your patients in network ensures that they benefit from the patient-centered care inherent to our clinically integrated network, while you benefit from better care coordination and communication with your colleagues.
FAQs for Health Plan Members
AHP is a clinically integrated network of physicians and hospitals – all of which participate in the networks of the region’s major insurance payers. AHP is not an insurance company or a health plan.
AHP’s clinical integration means that providers across the network have agreed to work together around common quality standards and clinical protocols that place you, the patient, at the center. Through efficient care coordination, AHP can deliver better clinical outcomes at the best value, which benefits your employer and the health plan.
If you are covered by an employer health plan contracted with AHP, your plan has been designed to encourage you to obtain care from AHP providers through lower copays, coinsurance and/or deductibles. If you choose to obtain care from providers outside of the AHP network, your plan still provides benefits for that care, but in most cases your out-of-pocket expenses will be higher.