WellCare Medical Home Enhanced Payment Program

Program Location: 
Atlanta, GA
Payer Type: 
WellCare Health Plans
Georgia Medicaid
PeachCare for Kids

In July 2013, WellCare implemented a program to encourage the use of the patient-centered medical home model within the Medicaid provider network. The objective is to have a centralized setting that fosters partnerships between individual patients, their primary care physicians, and when appropriate, the patient's family. Care is facilitated by registries, information technology, health information exchanges and other means to help ensure that patients get culturally- and linguistically-sensitive care when and where they need and want it.

WellCare is implementing enhanced payments for PCMH recognition and expanded services, and continuing pay-for-performance incentives for Georgia Medicaid providers that integrate this model into their physician practices.

Payment Model: 

This incentive program is based on the accreditation standards used by the National Committee for Quality Assurance (NCQA) to recognize the practice and/or the physicians as a PCMH. Practices are rewarded based on achieving three standards: establishment as a PCMH via NCQA accreditation, providing PCMH services such as enhanced access and care plan oversight, and meeting selected quality metrics.

Last updated July 2014
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