Cohort Payment Policy

Pay-for-Reporting Model

In 201 the BHT Board made several decisions regarding the allocation of Pay-for-Reporting Project dollars and categorization of Partners based on volume. You can read in detail about those decisions in the Funds Flow for 2019, 2020, & 2021 post.

The model states that Partners will be divided into three volume categories:

Large Providers: serving 20,001+ Medicaid Patients
Medium Providers: serving 1,201-20,000 Medicaid Patients
Small Providers: 1,200 or less Medicaid Patients

And also states that Pay-for-Reporting funds will be earned based on three categories of work.

40% Transformation Plan Milestones
40% Pay-for-Achievement Measures
20% Equity Activities & Milestones

In March of 2019 the Board made several more decisions that detail what activities will earn funds, a payment schedule, and minimum achievement. Those decisions are described below.

Earning Pay-for-Reporting Dollars

Over the next three years, a Partner’s earnings from each of the three categories of work and will be based on a combination of selecting measures, then reporting on and meeting those measures. Additionally, Partners will be earning funds based on completing specific activities required by BHT and the HCA.

As a reminder, Pay-for-Reporting and Pay-for-Performance are two different buckets of Project Funds.  Pay-for-Performance funds are earned by the region, for meeting the measures created by the Health Care Authority (HCA). These “at-risk” dollars will make up an increasing portion of our total Project Funds over the next three years.

Pay-for-Reporting Distribution by Partner

Between 2019 and 2021, approximately $17.6M of the total Pay-for-Reporting funds will be allocated to Collaboratives Partners. The table shows the potential Pay-for-Reporting earnings (per Partner), over the next three years:

Pay-for-Reporting_Distribution by Partner.png

Pay-for-Reporting Payments At-Risk

Partners will earn the majority of these Pay-for-Reporting funds based on timely and complete reporting. However, a portion of funding associated with both Transformation Plan Milestones and Pay-for-Achievement Measures will be “at risk” as the expectation for Partners to earn based on achievement increases (similar to the risk that the region has with the Pay-for-Performance funds described above). Meaning that to earn that portion, Partners must meet the Milestones specified in Addendum 3.01 of their Project Specific Agreement (“Contract”), and achieve the standards set for their selected Pay-for-Achievement Measures specified in Addendum 3.02.

In the event that a Partnering Provider meets some, but not all, of its Milestones and Pay-for-Achievement Measures, BHT will calculate partial payments on the “at-risk” portion. The at-risk payment tiers and criteria are as follows:

Pay-for-Reporting_Partial Payment Criteria.png

2019-2020 Contract Payment Schedule

Year 1 Contract start dates are April 1, 2019 for our January Cohort and October 1, 2019 for the August Cohort. Contracted Partners will earn funds from the above work categories, in three scheduled distributions. To view a Year 1 Contract payment breakdown by volume, including the amount at-risk, click on one of the following:

January Cohort - Large | Medium | Small
August Cohort - Medium | Small

Unearned “At-Risk” Pay-for-Reporting Funds

Any at-risk dollars not earned by Partners will be held in an unearned funds pool. The Board will decide how to use those dollars based on recommendations from our Waiver Finance Workgroup.

Update: See the Low Performance Policy Amendment passed Oct. 2019 by the Board.