JLN Process - Provider rate  

Process Group

Provider rate

Objective

Optimize payments to reflect realistic economic conditions while minimizing medical loss ratio

Input

• Standards of physician care (i.e., national boards), fair market value for services

• Medical loss ratio

Output

• Fee schedule

• Update provider payment amount

Measurable Outcome

Establish a fee schedule such that the maximum number of persons can receive services while ensuring sufficient supply of providers

Sources

• Joint Learning Network, 2012

• File: NHIIS_Phase_1_Public_Report_JLN_IT_Workshop_FINAL_Jan182012_A4.pdf