region/plan-specific news
: California
Eligible California outpatient groups and solo practitioners to receive bonus in 2022
In our 2022 budget, Magellan* has committed to making $1 million in bonus payments to California providers for their high-quality outpatient services rendered during the measurement period of July 1, 2021 through June 30, 2022.
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How will Magellan calculate the bonus payments?Magellan will calculate bonus payments as a percentage of each outpatient provider’s submitted Magellan claims. Who's eligible?All in-network, outpatient providers in California are eligible to receive a bonus, provided they met the quality and value criteria, and saw 30 or more Magellan members during the measurement period. |
Quality metrics include:
Access and availability measures
- Engagement and retention: New patient engagement and retention in outpatient treatment.
- Accepting new patients: Number of new patients admitted to the practice.
- Outpatient visits / patient: Average number of sessions per patient compared to network peers with similar practices/patient mix.
- 7-day follow-up with new patients: New patients seen within seven days of discharge from an inpatient hospital.
- 30-day follow-up with new patients: New patients seen within 30 days of discharge from an inpatient hospital.
Quality measures
- Average inpatient admissions: Average number of inpatient admissions among your existing patients during the reporting period compared to network peers.
- 7-day follow-up with existing patients: Existing patients seen within seven days of discharge from an inpatient hospital.
- 30-day follow-up with existing patients: Existing patients seen within 30 days of discharge from an inpatient hospital.
- Number of 30-day readmissions: Total number of inpatient readmissions for existing patients during the reporting period.
When will the bonuses pay out?
We estimate making the bonus payments for services rendered for the measurement period by the end of 2022.
We look to continue this program in 2023 with a similar bonus payment and structure. Maximize your 2023 bonus potential by 1) having high scores in the above-referenced quality metrics, and by 2) rendering services to 30 or more Magellan members during the measurement period.
*In California, Magellan does business as Human Affairs International of California, Inc. and/or Magellan Health Services of California, Inc. – Employer Services.