Record Detail

PROGRAM SPONSORSHIP Formal name of the incentive and/or reward program initiative (if applicable) Program name Clinical Diabetic Quality Bonus Program Program sponsor(s) and parent organization of sponsor(s), if applicable Program sponsor(s) HealthAmerica Primary program contact information Name Joshua Bennett, MD Title Vice President, Quality and Cost Management Organization HealthAmerica Email jhbennett@cvty.com Sponsoring organization type Health Plan(s) Single HMO 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 1000 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 500 Start date & end date of the program Start Date 6/5/2006 End ongoing   PROGRAM SCOPE Geographic scope of program Pennsylvania Individuals affected by program as a percentage of total population, if known Employer/commercial health plan- active workers (indicate %) 40 Employer/commercial health plan- dependents (indicate %) 5 Employer/commercial health plan- retirees (indicate %) 15 Medicare (indicate %) 40 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 Specialists Indicate the specialities Family Practice, Geriatric Medicine, Internal Medicine Physician unit Medical group Consumers- health plan enrollees (for health plan respondents only) HMO HMO/POS Medicare Recruitment of program targets Mandatory- all members of target group that meet certain criteria Specify Minimum total patient/enrollee volume PROGRAM PERFORMANCE MEASURES Outpatient clinical and safety measures included in the program Measure sources Bridges to Excellence Measurement areas Other measurement areas Diabetes Health plan performance measures Performance measure weighting Clinical performance % or N/A 100 Safety % or N/A 0 HIT adoption % or N/A 0 Cost % or N/A 0 Data Reliability Sources of data Existing or new data Existing data sources Data type Administrative in origin (derived from claims data) Data extracting entity Other Data aggregator/analyzer Other Ensures data accuracy No INCENTIVE/REWARD CHARACTERISTICS Start date & end date of the incentive/reward Start Date 09/01/06 End Date Ongoing Structure of the incentive or reward Direct financial reward- increased payment Lump-sum bonus Indirect financial reward Publicize good performance Target audience for publication of performance To consumers Structure of the incentive or reward for programs targeted at consumers Financial reward - direct Cash reward or reward of monetary value Specify dollar amount $100/year/diabetic member Scoring used to determine payment Absolute goals- population level measures Pay for meeting one overall measure/group of measures Frequency of reward or penalty Bi-annually Time lag between measurement and receiving reward/penalty One - three months Total dollar amounts awarded during the most recent calendar year $120,000 Source of financial payments for meeting performance goals New funding -internal COLLABORATION CHARACTERISTICS Phases of program where sought target collaboration Did not seek collaboration Receives compensation for administrative burden of data collection No Characteristics of post-implementation target feedback None of the above PROGRAM EVALUATION How the program evaluates its success Improvements in health status of population Sponsor financial return on investment (ROI) Evaluator Program sponsor Additional results of program evaluation We have found decreased emergency room use, improved lab data and decrease in overal medical costs for the population affected by this program Lessons learned from designing and implementing the program It takes quite a long time for the providers to do the chart audits required for the Bridges to Excellence model and NCQA DPRP certification. In some cases over a year went by before the practice received certification.

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