Provider Insider

Contracting

| Issue No.

As we demonstrate growing strength in our value-based care efforts as a network, our contracting team has been working hard to ensure that our contracts for 2022 offer greater opportunities for financial success. The payer agreements we are participating in for calendar year 2022 are outlined here. If deemed eligible by the payer, your practice will be required to participate in all of the 2022 C3 commercial agreements. In 2024, the same will be true for the C3 Medicare Advantage agreements. Our network is now managing close to 200,000 lives in these value-based agreements, and we are grateful for your hard work in contributing to the network’s success!

 

Revenue Opportunities

Payer Prospective Per Patient Care Coordination Fees Annual Shared Savings/
Quality Incentives
Aetna Medicare Advantage   X
Anthem Commercial
Cooperative Care
X X
Anthem Medicare Advantage X X
Cigna Commercial
Collaborative Accountable Care (CAC)
X X
Cigna Medicare Advantage
Partnership for Quality Program (P4Q)
X X
United Commercial X X
United Medicare Advantage   X

 

It is important to note that our Anthem Commercial contract has a component of downside risk starting in 2022. This means that we, along with our payer partner, are accountable should the cost of care for those patients be higher than the funds received to cover that care.  As you may be aware, C3 has been preparing for this by creating a reserve pool of dollars to be used if we need to pay money back to Anthem, so that individual practices will not be affected.  And, at the practice level, your focus on annual wellness visits, keeping patients healthy and out of the emergency room, and using generic medications when appropriate will help us continue our positive performance.

Finally, as we look to the future and broadening our value-based opportunities, we are exploring other payer offerings as well as value-based Medicare offerings. You will hear more about this throughout 2022.

 

 

  1. Association for Accessible Medicines. accessiblemeds.org/resources/blog/2017-generic-drug-access-and-savings-us-report
  2. CARDS Trial. Lancet. 2004; 364 (9435): 685.
  3. HPS Substudy. Lancet. 2003; 361 (9374): 2005.
  4. Lemstra et al. Proportion and risk indicators of nonadherence to statin therapy: a meta-analysis. Canadian Journal of Cardiology. 2012; 28: 574.
  5. Mann et al. Predictors of non-adherence to statins: a systematic review and meta-analysis. Ann Pharmacother. Ann Pharmacother. 2010; 44 (9): 1410.
  6. Benner et al. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002; 288 (4): 455.