PROGRAM SPONSORSHIP |
Formal name of the incentive and/or reward program initiative (if applicable) |
| Program name |
PPO Pulse |
Program sponsor(s) and parent organization of sponsor(s), if applicable |
| Program sponsor(s) |
Blue Cross of California - PPO Pulse P4P Program |
| Parent organization |
WellPoint Inc. |
Primary program contact information |
| Name |
Jerry Low |
| Title |
Project Manager |
| Organization |
Blue Cross of California |
| Email |
jerry.low@wellpoint.com |
| Phone |
(818) 234-3798 |
Sponsoring organization type |
| Health Plan(s) |
Single PPO/other |
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 |
6/5/2002 |
| End |
ongoing |
PROGRAM SCOPE |
| Geographic scope of program |
California |
| Individuals affected by program as a percentage of total population, if known |
| Employer/commercial health plan- active workers |
|
| Employer/commercial health plan- dependents |
|
| Employer/commercial health plan- retirees |
|
|
| Plan product(s) the program applies to (for plan sponsors only) |
|
Direct target(s) of your program's incentives/rewards |
| Physician type |
| PCPs |
|
| Specialists |
| Indicate the specialities |
Family Practice, Internal Medicine, Obstetrics & Gynecology |
|
|
| Physician unit |
Individual physician/clinician |
| Recruitment of program targets |
| Mandatory- all members of target group that meet certain criteria |
| Specify |
Minimum number of patients for measures; Participation in certain health plan products; 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) |
|
| Other |
| Specify |
Evidence-based medicine clinical measures developed internally or by consultants; SurveyAnswerTextNull |
|
|
Measurement areas |
| Cardiac |
| Coronary artery disease (CAD) |
|
|
| Cancer screening |
|
| Pulmonary |
| Adult Asthma |
|
| Pediatric Asthma |
|
|
| Safety |
| Appropriate antibiotic prescribing for infections |
|
|
| Other measurement areas |
| Diabetes |
|
| Hypertension |
|
| Adult Preventive Care |
|
| Pediatric Preventive Care |
|
|
Resource Utilization and Cost |
| Resource utilization |
| Pharmaceutical usage- generic usage rate |
|
|
Health plan performance measures |
| Performance measure weighting |
| Clinical performance |
|
| Cost |
|
| Other |
|
|
Consumer measures |
| Additional details about your incentive/reward performance measurement mix |
CLINICAL QUALITY INDICATORS
Ace Inhibitor Use in CHF
Breast Cancer Screening
Cervical Cancer Screening
Childhood Immunizations: MMR
Childhood Immunizations: VZV
Chlamydia Screening
Colorectal Cancer Screening
Compliance with Lipid Lowering Drugs
Diabetes: Diabetic Retinal Exam
Diabetes: Glycosylated Hemoglobin Measured
Long-term Control Drugs for Asthma
Treatment of URI
GENERIC PRESCRIBING INDICATORS
Depression (SNRIs, SSRIs)
Hypertension (ACEI, ARBS, CCBs, BBs, Diuretic)
Hypercholesterolemia (HMGs)
Diabetes Metformin
Arthritis (NSAIDs, COX2s)
Ulcer (H2Ras, PPIs) |
Data Reliability
Sources of data |
| Existing or new data |
Existing data sources |
| Data type |
| Administrative in origin (derived from claims data) |
|
|
| Data extracting entity |
|
| Data aggregator/analyzer |
|
| Ensures data accuracy |
No |
| Risk-adjustment mechanisms used |
| Other |
| Specify |
Confidence Interval |
|
|
INCENTIVE/REWARD CHARACTERISTICS
|
Start date & end date of the incentive/reward |
| Start Date |
3/01/2004 |
| End Date |
ongoing |
Structure of the incentive or reward |
| Direct financial reward- increased payment |
| Percent of fees |
|
| Differential reimbursement for providers; (e.g., increase in rate of reimbursement) |
| Specify |
Increase in rate of reimbursement |
|
|
Scoring used to determine payment |
| Absolute goals- patient level measures |
| Pay for meeting specific sub goals related to overall measure/group of measures |
|
|
| Absolute goals- population level measures |
| Pay for meeting specific sub goals related to overall measure/group of measures |
|
|
| Relative goals |
| Relative ranking to peer group on each measure |
|
|
| Frequency of reward or penalty |
|
| Time lag between measurement and receiving reward/penalty |
|
| Total dollar amounts awarded during the most recent calendar year |
6% |
| 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 |
OUR METHODOLOGY:
Identify all eligible patient or pharmacy cases to be counted for each indicator and each physician.
Calculate the physician’s score for each indicator.
Create a physician composite score calculating the percentage of time that the recommended care was delivered
across all indicators within the composite.
If the number of eligible cases within the composite score is greater than 35, then the following two steps are performed.
Compare the physician’s composite score to a specialty peer mean.
Rate the physician composite score using a 95 percent confidence interval. The composite is then assigned a rating based on a comparison to the specialty peer mean. |
