Frequently Asked Questions
A: Value-based care is the future of healthcare. Under this healthcare delivery model, care is coordinated to improve patient outcomes while reducing costs. Unlike fee-for-service, value-based care incentivizes providers to focus on quality care.
A: Value-based care keeps healthcare costs down while keeping people healthy. With the support of a clinically integrated network, patients get the right care, at the right time, in the right place.
A: Memorial Health Network has been leading value-based care initiatives since 2013.
As a member of our network, you have exclusive access to the following:
• Memorial Employee Health Plan provider network
• Oscar Individual Exchange
• Oscar Medicare Advantage
• Memorial Power purchasing program at no cost
• Pharmacy support
• Practice-based support
• Care navigation programs
• Coding and documentation assistance
• Patient outreach campaign
A: Participation agreements with Memorial Health Network does not impact any existing contracts with insurance companies.
A: Memorial Health Network has partnerships with the following payors:
• United Healthcare
• Florida Blue
• Memorial Employee Health Plan (MEHP)
• Oscar (Individual Exchange and Medicare Advantage)
A: Patients are assigned every quarter as claims are received and processed. As reports are updated by our payors, we will adjust the number of patients assigned.
A: Patients are assigned by the health plan based on one of two criteria:
• A claim submitted by a primary care physician in the previous 12-24 months
• Member selection
If a patient appears on your attribution list, we encourage you to contact the patient to schedule an office visit.
A: Available reports include but are not limited to:
• Attribution reports
• Care gap reports (HEDIS)
• Progress reports
• ED Familiar Faces
• Hits to goal
• Pharmacy opportunity
A: All reports are claims-based and run quarterly. Because of the claims run-out period, quarter four reports are typically not available until May of the following year. This is standard in the industry and ensures all encounters and claims for the year are captured.
A: Gaps are not closed in our system until the claim is submitted to the payor by the rendering provider. All reports will be updated once the claim is processed and submitted to our team in the monthly claims feed. This process can take between two to three months.