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Payment Incentives

Last Updated 10/30/13

Aligning Payment with Quality

The Oregon Health Authority (OHA) is working with public and private payers across Oregon to pursue innovative payment methods that move us toward a health care system that rewards quality, patient-centered care. To meet that goal, OHA is currently developing options to foster recognized primary care homes through a multi-payer strategy for support. Click here for more information. ​​​​​

Current Payment Incentive Opportunities for Recognized Primary Care Homes

Public Employees' Benefit Board

The Public Employee's Benefit Board (PEBB) provides an age-adjusted, per-member-per-month incentive payment to Tier 2 or Tier 3 recognized primary care homes in the PEBB Statewide plan, administered by Providence Health & Services. In addition, PEBB members in the PEBB Statewide plan have lower cost share for primary care services when they access care through a recognized primary care home - from 15 to 10 percent.

Coordinated Care Organizations

The Coordinated Care Organizations (CCO) your clinic contracts with may offer incentive payments for recognized primary care homes. Please check with your CCO representative to inquire about alternative payment methods that may be available.

Aetna

Aetna's Patient Centered Medical Home (PCMH) recognition program offers per-member-per-month payment incentives using the PCPCH tiers, and is available to physician practices in Oregon that meet certain criteria: Directly contracted with Aetna; Received recognition by the NCQA or by the State of Oregon Patient-Centered Primary Care Home program as a PCPCH; Have 10 or more attributed Aetna members; and be reimbursed at 100% of the Aetna Market Fee Schedule (AMFS). Questions about this program can be directed to Denise Casner, Network Manager, at 503-937-0621, or by email to CasnerD@aetna.com.

Other Federal Payment Initiatives for Primary Care

Medicare

The Affordable Care Act (ACA) Section 5501(a) created the Primary Care Incentive Payment program to offer an incentive payment to qualifying primary care physicians and non-physician practitioners who furnish primary care services to Medicare patients. To be eligible for the incentive payment, qualifying services must be rendered between January 1, 2011, and December 31, 2015. Providers in Oregon received approximately $4.3 million under this program in 2011. 

Comprehensive Primary Care Initiative

Oregon is one of seven markets selected to participate in this four year, multi-payer federal initiative to strengthen primary care capacity by testing a model of comprehensive, accountable primary care supported by multiple payers. Nearly 70 Oregon primary care practices were selected to participate and each is required to be recognized as a Patient-Centered Primary Care Home and to achieve certain Centers for Medicare and Medicaid Services (CMS) milestones over the four years. Please note that no new clinics are eligible for the initiative at this time.

Enhanced payments to the selected practices began in November 2012 from CMS and five Oregon payers including Regence Blue Cross, Providence Health Plan, CareOregon, Tuality and the OHA (Medicaid FFS). Visit the Comprehensive Primary Care Initiative webpage for more information.

Medicaid

The Affordable Care Act also directs a temporary increase for primary care physicians who see Medicaid patients in 2013 and 2014. The increase in payments will bring Medicaid primary care service fees in line with those paid by Medicare. The extra payments are intended to encourage primary care physicians to provide more checkups, preventive screenings, vaccines and other care for Medicaid beneficiaries. States will receive 100 percent federal matching funds for the increase in payments.

Medicaid Affordable Care Act Section 2703 payments

The time-limited supplemental payments available through the Affordable Care Act Section 2703 for recognized primary care homes ended September 30, 2013. Primary care homes were eligible for enhanced payments under a provision of the ACA from October 2011 - September 2013. Please note that these payments are no longer available and all 2013 patient lists must have been submitted by December 31, 2013.

Resources and Technical Assistance to Practices

The Oregon Health Authority and the Northwest Health Foundation, in partnership with the Oregon Health Care Quality Corporation, launched the Patient-Centered Primary Care Institute in September 2012 to support primary care practice transformation in Oregon. A broad array of resources are available now. Please visit www.PCPCI.org.

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