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Payment

Plans must cover the same benefits as Traditional Fee-For-Service (FFS) Medicare, and these payments are risk adjusted to reflect the specific characteristics and anticipated cost of providing care to each beneficiary. Within this capitated payment, plans, providers, and community-based partners must work together to effectively care for the beneficiary. The goal of managing within a fixed payment is to encourage coordinated care that emphasizes prevention, customized care, and innovation to improve outcomes and prevent avoidable adverse events.

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