Primary Care Provider Reimbursement Project

Client: Health Plus
Faculty: Amy Goldman, Roger Kropf
Team: Phong Bui, Nicole Krop Casey, Adam DeVito, Melanie Pessin, Gina Scibelli
Year: 2011
Health Plus is a Medicaid Managed Care plan serving over 300,000 patient mem­bers throughout the New York Metropolitan area. Health Plus aims to improve provider satisfaction and better incentivize quality of care. To accomplish this goal, the Capstone team researched Primary Care Provider (PCP) reimbursement models and assessed potential changes to the current payment strategy. In addition, Health Plus requested that the team research the Patient Protection and Affordable Health Care Act and outline how the new law will impact its business in a competitive market. To this end, the team conducted extensive research on federal healthcare reform legislation and emerging trends in primary care reimbursement, surveyed and interviewed a representative sample of Health Plus' PCPs, and developed a marketing tool for Health Plus to explain its reimbursements to its provider network.