What is required of managed care plans contracting with Medicare or Medicaid regarding physician incentive plans?

Managed care plans that contract with Medicare or Medicaid are required to disclose information regarding physician incentive plans before the approval of the contract. This requirement is in place to ensure transparency and accountability within the healthcare system, particularly in how incentives are structured to promote quality care rather than quantity of services.

When managed care organizations utilize physician incentive plans, they must provide details about how these incentives work, including any potential risks for overutilization or underutilization of services. This pre-contract disclosure allows the government and other stakeholders to evaluate whether the incentive structures align with the goal of providing high-quality care to beneficiaries.

By requiring disclosure before contract approval, regulatory bodies aim to safeguard patient care, ensuring that any incentives offered to healthcare providers do not compromise patient outcomes or lead to unnecessary treatments. This focus on transparency helps to maintain the integrity of managed care programs under Medicare and Medicaid.