Record Detail

PROGRAM SPONSORSHIP Formal name of the incentive and/or reward program initiative (if applicable) Program name Colorado & Nevada Primary Care PHQ Program sponsor(s) and parent organization of sponsor(s), if applicable Program sponsor(s) Anthem Blue Cross and Blue Shield Colorado, Anthem Blue Cross and Blue Shield Nevada Parent organization WellPoint Inc. Primary program contact information Name Jerry Low Title Project Manager Organization Anthem Blue Cross and Blue Shield Colorado & Nevada Email jerry.low@wellpoint.com Phone (818) 234-3798 Sponsoring organization type Health Plan(s) Single HMO, Multiple health plans Source of funding associated with program set-up costs Funding source Funded by program sponsor(s) Percent contributed by sponsor and grant organization % Sponsor 100 Program set-up costs 0 Source of funding associated with program operations costs Funding source Funded by program sponsor(s) Percent contributed by sponsor and by grant organization % Sponsor 100 Program operations cost 0 Start date & end date of the program Start Date 6/5/2004 End ongoing   PROGRAM SCOPE Geographic scope of program Colorado, Nevada Individuals affected by program as a percentage of total population, if known Employer/commercial health plan- active workers (indicate %) NA Employer/commercial health plan- dependents (indicate %) NA Employer/commercial health plan- retirees (indicate %) NA Plan product(s) the program applies to (for plan sponsors only) HMO HMO/POS Direct target(s) of your program's incentives/rewards Physician type PCPs Physician unit Medical group Recruitment of program targets Mandatory- all members of target group that meet certain criteria Specify Minimum total patient/enrollee volume; Minimum number of patients for measures; Location in targeted geographic area PROGRAM PERFORMANCE MEASURES Outpatient clinical and safety measures included in the program Measure sources Ambulatory care Quality Alliance (AQA) HEDIS (clinical components) Measurement areas Cancer screening Breast Cervical Colon Prostate Pulmonary Adult Asthma Other measurement areas Diabetes Hypertension Pediatric Preventive Care Health plan performance measures Performance measure weighting Clinical performance % or N/A 100 Other Specify HMC Care Profiles Consumer measures Additional details about your incentive/reward performance measurement mix Clinical Quality Indicators: ACE/ARB for Diabetes Mellitus Adolescent Immunizations Adults with Asthma Breast Cancer Screening Cervical Cancer Screening Childhood Asthma Childhood Immunizations Colorectal Cancer Screening Diabetes - HbA1c Diabetic Nephropathy Prostate Screening Antigen Warfarin Generic Prescribing Indicator Classes: Hyperlipidemia Hypertension Other Indicators: HMC Care Profiles Data Reliability Sources of data Existing or new data Existing data sources Data type Administrative in origin (derived from claims data) Medical record data Data extracting entity Program target Data aggregator/analyzer Program sponsor Ensures data accuracy No INCENTIVE/REWARD CHARACTERISTICS Start date & end date of the incentive/reward Start Date 07/01/2004 End Date ongoing Structure of the incentive or reward Direct financial reward- increased payment Lump-sum bonus Percent of fees Differential reimbursement for providers; (e.g., increase in rate of reimbursement) Specify Fee Schedule Change Scoring used to determine payment Absolute goals- patient level measures Pay for meeting one overall measure/group of measures Pay for meeting specific sub goals related to overall measure/group of measures Absolute goals- population level measures Pay for meeting one overall measure/group of measures Pay for meeting specific sub goals related to overall measure/group of measures Frequency of reward or penalty Annually Time lag between measurement and receiving reward/penalty Greater than six months Source of financial payments for meeting performance goals Current budget redistributed Shared savings breakdown (percentage should add to 100) if applicable Additional details about the incentive/reward characteristics and scoring methodology Reporting & Measuring Quarterly member data provided to groups Annual report card Groups choose from menu of clinical and pharmacy measures Group results compared against national average, regional average or plan rates Target Rates Stretch Target Rates Financial incentives for meeting targets COLLABORATION CHARACTERISTICS Phases of program where sought target collaboration Program design and creation Characteristics of pre-implementation target feedback Provider participation in program design Receives compensation for administrative burden of data collection No Characteristics of post-implementation target feedback Process available for target to provide additional information and/or corrections Blinding of performance feedback with targets Confidential Frequency of performance feedback to the targets Quarterly PROGRAM EVALUATION How the program evaluates its success Improvements in clinical performance Evaluator Program sponsor

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