Kadernota 2014 - Gemeente Venlo

8 Health Care Professional CompensationHealth Care Professional CompensationCigna is committed to keeping youinformed about matters related to yourhealth care plan. For that reason, weoffer the following description of theway that Cigna compensates health careprofessionals (physicians, hospitals andother health care practitioners andfacilities) that participate in ournetworks.Cigna compensates health careprofessionals in ways that are intended toemphasize preventive care, promotequality care and ensure the appropriateand cost-effective use of coveredmedical services and supplies. Cignareinforces this philosophy throughutilization management decisions madeby its medical directors and medicalmanagement staff. Cigna employees areencouraged to promote appropriateutilization of covered health careservices and to discourageunderutilization.The methods by which participatinghealth care professionals agree to becompensated are described generallyhere. The amount and type ofcompensation a health care professionalagrees to accept may vary dependingupon the type of plan. For example, ahospital may agree to accept less forservices provided to patients enrolled inan HMO plan than to patients enrolled inother types of plans. In addition, Cignamay attempt in various ways to promotethe use of participating health careprofessionals based upon quality andcost-effectiveness measures whileassuring quality and access to coveredservices and supplies.DISCOUNTED FEE FORSERVICE:Payment for services is based on anagreed-upon discounted amount from thehealth care professional’s bill.CAPITATION:By mutual agreement, networkphysicians, physician/hospitalorganizations (PHOs) or other healthcare professional groups are paid a fixedamount (capitation) at regular intervalsfor each individual assigned to thephysician, PHO or other health careprofessional groups, whether or notservices are provided. This paymentcovers physician and/or, whereapplicable, hospital or other servicescovered under the benefits plan. Healthcare professional groups and PHOs mayin turn compensate health careprofessionals using a variety of methods.Capitation can offer health careprofessionals a predictable income,encourage physicians to keep peoplewell through preventive care, eliminatethe financial incentive to provideservices that will not benefit the patientand reduce paperwork.Cigna may also work with third partiesthat provide network managementservices. Under these arrangements,Cigna pays the third party a fixedmonthly amount per individual for theseservices. Health care professionals arecompensated by the third party forservices provided to Cigna planparticipants from the fixed amount.Compensation arrangements are agreedupon by the third parties and theircontracted health care professionals, andmay include discounted fee for serviceand capitation.Some health care professionals and thirdparties that provide networkmanagement services may participate ina risk-sharing arrangement with Cigna;they agree on a target amount for thecost of certain services and share all orsome of the amount by which costs areover or under the target. Services aremonitored using criteria that mayinclude accessibility, quality of care,customer satisfaction and appropriateand cost-effective use of medicalservices and supplies.SALARY:Physicians and other health careprofessionals who are employed to workin Cigna's Arizona staff-model medicalfacility are paid a salary. The salary isdecided in advance each year and isguaranteed regardless of the servicesprovided. Physicians are eligible for abonus at the end of the year based onperformance, which is evaluated usingcriteria that may include quality of care,quality of service and appropriate andcost-effective use of medical servicesand supplies.BONUSES AND INCENTIVES:Some health care professionals mayreceive additional payments based ontheir performance, which is measuredusing criteria that may include quality ofcare, quality of service and appropriateand cost-effective use of medicalservices and supplies. Health careprofessionals may also receive financialand/or nonfinancial incentives thatpromote utilization of cost-effectiveparticipating health care professionals(such as hospitals, labs, specialists andvendors) and covered drugs and supplies.PER DIEM:A specific amount is paid to a hospitalper day for all health care received. Theper diem payment may vary by type ofservice and length of stay and thepayment may in some cases be greaterthan the hospital’s normal billed charges.CASE RATE:A specific amount is paid for all healthcare received in the hospital for a givenhospital stay (such as for a normalmaternity delivery).If you would like to find out whichcompensation method applies to servicesyou receive from a health careprofessional, just ask the doctor’sadministrative staff. Cigna CustomerService is available to help with generalquestions at the toll-free telephonenumber on your Cigna ID card.