As healthcare continues to evolve, traditional fee-for-service models are being replaced by value-based contracting. This is an approach that rewards providers for delivering high-quality, efficient, and patient-centered care.

Value-based contracts tie a portion of reimbursement to performance on cost, quality, and outcomes. This model encourages proactive care, care coordination, and population health management, which leads to better patient outcomes and reduced unnecessary spending.

At GMP Network, we help independent practices thrive in value-based arrangements by:

• Supporting performance in quality programs like PGIP
• Providing tools for risk stratification, HCC coding, and care gap closure
• Offering data insights and care management support to drive improved outcomes

Value-based contracting is no longer optional, it's the future of sustainable, independent practice. GMP Network ensures you’re positioned to succeed.

Types of Contracts GMP Network Offers:

Value-Based Reimbursement with Demonstrated Outcomes

This model ties payment directly to the quality and effectiveness of care provided. Providers are rewarded for meeting key clinical and efficiency benchmarks, such as improved chronic disease management, reduced hospitalizations, and higher patient satisfaction. Success is based on measurable outcomes, not just services delivered. A value-based reimbursement (VBR) is a percentage uplift applied to select BCBSM reimbursement codes.

Shared Savings

In a shared savings model, providers can earn a portion of the savings they help generate by delivering cost-effective care while maintaining or improving quality. Practices are incentivized to reduce unnecessary spending (like avoidable ER visits or hospital admissions) and work collaboratively across the care team.

Capitated Risk – Upside Only

Under a capitated model, providers receive a per-member-per-month (PMPM) payment to manage the care of a defined population. In an upside-only risk arrangement, providers keep a portion of any savings generated by staying under budget but are not penalized if costs exceed expectations. This encourages efficiency and proactive care while minimizing financial risk to the practice.

What is Pay for Performance (P4P)?

Pay for Performance (P4P) is a healthcare reimbursement model that rewards providers for meeting specific quality and efficiency benchmarks. Instead of being paid only for the number of services delivered, providers receive additional compensation when they achieve high performance on key measures such as:

• Preventive screenings (e.g., cancer, diabetes)
• Chronic disease management (e.g., hypertension, diabetes)
• Patient satisfaction and access to care

P4P encourages continuous improvement and accountability in patient care. At GMP Network, we help practices succeed in P4P programs by offering quality data insights, documentation support, and care management tools.