Record Detail

PROGRAM SPONSORSHIP Formal name of the incentive and/or reward program initiative (if applicable) Program name Immunization and Well-Child Incentive Program Program sponsor(s) and parent organization of sponsor(s), if applicable Program sponsor(s) Department of Social and Health Services, Health and Recovery Services Administration, Medicaid Managed Care Parent organization Department of Social and Health Services Primary program contact information Name Barbara Lantz Title Contract Manager Organization Health and Recovery Services Administration Email lantzbk@dshs.wa.gov Phone (360) 725-1640 Sponsoring organization type Multiple Sponsors Employer/health plan/hospital coalition Government(s) State Health Plan(s) 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 2 Start date & end date of the program Start Date 1/1/2004 End ongoing   PROGRAM SCOPE Geographic scope of program Washington Individuals affected by program as a percentage of total population, if known Medicaid (indicate %) 40 Coverage of affected individuals (for purchaser sponsors only) HMO Plan product(s) the program applies to (for plan sponsors only) HMO Direct target(s) of your program's incentives/rewards Health plans (for employers that reward plans only) HMO Medicaid Recruitment of program targets Mandatory- all members of the target group must participate (e.g. part of contracting) PROGRAM PERFORMANCE MEASURES Outpatient clinical and safety measures included in the program Measure sources HEDIS (clinical components) Measurement areas Other measurement areas Pediatric Preventive Care Health plan performance measures Performance measure weighting Other Specify 100 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 Other Ensures data accuracy Yes Means of ensuring accuracy Auditing Specify who audits and how often Contracted HEDIS Audit annually Risk-adjustment mechanisms used None of the above INCENTIVE/REWARD CHARACTERISTICS Start date & end date of the incentive/reward Start Date 01/01/2004 End Date ongoing Structure of the incentive or reward Direct financial reward- increased payment Lump-sum bonus Upper reward limit 1 million each for 2 year old immunization measure and all 3 well-child measures Structure of the incentive or reward for programs targeted at consumers Financial reward - direct Cash reward or reward of monetary value Scoring used to determine payment Relative goals Relative ranking to peer group on each measure Frequency of reward or penalty Annually Time lag between measurement and receiving reward/penalty Three - six months Total dollar amounts awarded during the most recent calendar year 2 million 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 The total quality payment to each plan is the sum of two independent calculations, one for immunizations and another for well-child visits. DSHS has set aside $1,000,000 to be paid for each of the two analyses. Each calculation is comprised of a point system that rewards plans for both their current year performance relative to the other plans and for their improvement from previous year to current year relative to the other plans. 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 Incentive target groups/individuals given comparative information Blinding of performance feedback with targets Full public reporting Frequency of performance feedback to the targets Annually PROGRAM EVALUATION How the program evaluates its success Improvements in clinical performance Evaluator Program sponsor Additional results of program evaluation Continuous improvement observed in 2 year old immunization measure among all plans reporting. Variable performance observed in well-child care for all 3 measures. Lessons learned from designing and implementing the program Health plans need to show continuous improvement over time to receive incentive (e.g., health plan variable or lower performance on well-child care should not lead to an incentive payment. Because the payment is relative to other plan performance, if the rates go down across all plans, they are still eligible for incentive. We did change the specifications requiring continuous improvement in third year of incentive program.

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