Virginia Law

The commissioner may condition the approval of the authorization letter on the applicant's commitment to achieving improvements to population health, access to health care services, quality, and cost-effectiveness identified by the applicant in support of the application. The conditions may include:

1. A cap on the negotiated case-mix adjusted revenue per discharge by payer by product;

2. A commitment to return a portion of the cost savings and efficiencies gained through the cooperative agreement to residents in the participating localities through specific proposed mechanisms;

3. An agreement that the parties may not prevent or discourage health plans from directing or incentivizing patients to choose certain providers;

4. An agreement that the parties may not have any contractual clauses or provisions that prevent health plans from directing or incentivizing patients;

5. An agreement that the parties may not engage in the typing of sales of the health system's services with the health plan purchase of other services from the health system;

6. An agreement that the parties may not restrict a health plan's ability to make available to its health plan enrollees cost, quality, efficiency, and performance information to aid enrollees in evaluating and selecting providers in the health plan;

7. A commitment that the parties may not refuse to include certain provisions in contracts with health plans that have been utilized in health plan contracts in other parts of the Commonwealth in order to promote value-based health care, including bundled payments, pay for performance, utilization management, and other processes that reward improvements in quality and efficiency; and

8. A commitment to reduce the total cost of care and improve the quality of care in the region served by the new entity.