Contracting

Ask the Expert: PMPM Payments for Case Management

October 25, 2012 11:33 am

Q: Our institution has started to create a medical home delivery system. One of the health plans that is interested in this has offered a small PMPM payment to cover case management. How can we know if the plan’s offer is reasonable? 

A: You should expect the PMPM to cover the salary and benefits of the case manager(s) required to handle the population. Typically, there is one case manager for a 10,000 population for commercial, and one for a 5,000 to 7,500 population for Medicaid and Medicare. In addition, the PMPM should cover the additional technology required for reporting to the payer.


Two Forum experts answered this question together: Dawn Boyd, director, managed care contracting, The Godbey Group, Irving, Texas, and Dan McAffee, senior managing director, payor contracting and reimbursement strategy, The Godbey Group.

Ask Dawn, Dan, or one of our other Payment & Reimbursement Forum experts a question
 

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