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Analysis of Payments to Doctors, Hospitals in Virginia from Medicaid MCOs

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Over two-thirds of the health care payments (67%) paid to doctors and hospitals in Virginia by the commercial sector in 2016 contain incentives to improve the cost and quality of care patients receive. Similar to trends nationwide, in the Medicaid sector 37% percent of payments were tied to value in 2016. These are among the findings of The Virginia Scorecards on Payment Reform released by Catalyst for Payment Reform (CPR), the Virginia Center for Health Innovation and the Virginia Association of Health Plans. The Virginia Scorecards on Payment Reform are based on an independent review of data from commercial and Medicaid managed care plans that collectively insured 4.6 million Virginians in 2016, the year on which the report bases its findings.  Both The Virginia Scorecard on Commercial Payment Reform and The Virginia Scorecard on Medicaid Payment Reform aggregate data from health plans from calendar year 2016. CPR obtained the data through an online survey of health plans, with five commercial health plans responding, who together cover approximately 72% of the commercially-insured lives in Virginia, and four Medicaid managed care organizations responding, who together cover approximately 58% of the Medicaid-insured lives in Virginia.

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