METHOD AND APPARATUS FOR PROVIDING INCENTIVES TO PHYSICIANS UNDER ACCOUNTABLE CARE MODELS AND OTHER HEALTHCARE DELIVERY MODELS

摘要

Embodiments are directed to a method of providing a monetary incentive to a health care provider, typically a physician, responsible for treatment decisions of a patient with a condition during an episode of care. Once the patient identity and condition are obtained, a baseline value related to treatment of the condition can be associated. Thereafter, all the claims processed during the episode of care of the patient for the condition can be summed to obtain a total treatment cost. If the total treatment is less than the baseline value, then a monetary incentive can be provided to the provider based upon that episode of care. The healthcare provider may be a member of a managed care organization, such as an accountable care organization, and the monetary incentive may be modified based on time interval for the episode of care.