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A TRUE COPY CERTIFICATION ON LAST PAGE RYAN L. BUTLER, CLERK Patient -Centered Medical Home (PCMH): A model of care in which each patient has an ongoing relationship with a primary care physician who coordinates a team to take collective responsibility for patient care and, when appropriate, arranges for care with other qualified physicians. Shared Savings: A payment mechanism in which the provider and payer share cost savings achieved against a target cost budget based upon agreed upon terms and may include downside risk. Value -Based Program (VBP): An outcomes -based payment arrangement and/or a coordinated care model facilitated with one or more local providers that is evaluated against cost and quality metrics/factors and is reflected in provider payment. Value -Based Programs Overview Employer's Members may access covered healthcare services from providers that participate in a Host Blue's Value -Based Program. Value -Based Programs may be delivered either through the BlueCard Program or a Negotiated Arrangement. These Value -Based Programs may include, but are not limited to, Accountable Care Organizations, Global Payment/Total Cost of Care arrangements, Patient Centered Medical Homes and Shared Savings arrangements. Value -Based Programs under the BlueCard Program Under Value -Based Programs, a Host Blue may pay providers for reaching agreed upon cost/quality goals in the following ways: The Host Blue may pass these provider payments to BCBSF and/or its Designated Agent, which BCBSF and/or its Designated Agent will pass directly on to Employer as either an amount included in the price of the claim or an amount charged separately in addition to the claim. When such amounts are included in the price of the claim, the claim may be billed using one of the following pricing methods, as determined by the Host Blue: (i) Actual Pricing: The charge to accounts for Value -Based Programs incentives/Shared Savings settlements is part of the claim. These charges are passed to Employer via an enhanced provider fee schedule. (ii) Supplemental Factor: The charge to accounts for Value -Based Programs incentives/Shared Savings settlements is a supplemental amount that is included in the claim as an amount based on a specified supplemental factor (e.g., a small percentage increase in the claim amount). The supplemental factor may be adjusted from time to time. When such amounts are billed separately from the price of the claim, they may be billed as follows: (i) Per Member Per Month (PMPM) Billings: Per Member per month billings for 12