Record Detail

PROGRAM SPONSORSHIP Formal name of the incentive and/or reward program initiative (if applicable) Program name PCP Recognition Program Program sponsor(s) and parent organization of sponsor(s), if applicable Program sponsor(s) BlueChoice, Inc. Parent organization CareFirst BCBS Primary program contact information Name Peggy Reineking Title Manager Performance Based Programs Organization CareFirst BCBS Email Peggy.Reineking@carefirst.com Phone (410) 872-3668 Sponsoring organization type 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 0 Start date & end date of the program Start Date 1/1/1998 End 12/31/2007   PROGRAM SCOPE Geographic scope of program District of Columbia, Maryland, Virginia Individuals affected by program as a percentage of total population, if known Employer/commercial health plan- active workers (indicate %) 50 Employer/commercial health plan- dependents (indicate %) 50 Coverage of affected individuals (for purchaser sponsors only) HMO HMO/POS 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 Consumers- employer covered lives (for employer respondents only) Salaried employees Hourly employees Union Non-union Full-time Part-time Dependents Retirees Consumers- health plan enrollees (for health plan respondents only) HMO HMO/POS Health plans (for employers that reward plans only) HMO HMO/POS 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; Participation in certain health plan products; Participation in patient satisfaction or experience of care survey PROGRAM PERFORMANCE MEASURES Outpatient clinical and safety measures included in the program Measure sources HEDIS (clinical components) Other Specify Efficiency, cost of care or utilization measures developed internally or by consultants; Patient surveys from any source including CAHPS; Internal Measures Measurement areas Other measurement areas Adult Preventive Care Pediatric Preventive Care Resource Utilization and Cost Resource utilization Other Specify episode-based efficient use of medical resources Cost Total cost in Episode Treatment Groups (ETGs) Other Specify cost in MEGS (medstat's grouper) Health plan performance measures Health plan measures Cost/efficiency measures Performance measure weighting Clinical performance % or N/A 9 Safety % or N/A 0 Cost % or N/A 40 Other Specify good business practices Consumer measures Enrollment in high-value health plan Other Specify participation in HMO network Data Reliability Sources of data Existing or new data Existing data sources, New data collected explicitly for program reporting Data type Administrative in origin (derived from claims data) Data extracting entity Program target Data aggregator/analyzer Program sponsor Ensures data accuracy Yes Means of ensuring accuracy Auditing Specify who audits and how often Internal audit arranges for ad hoc audit Risk-adjustment mechanisms used Other Specify MEGS INCENTIVE/REWARD CHARACTERISTICS Start date & end date of the incentive/reward Start Date 1/1/1998 End Date 12/31/2007 Structure of the incentive or reward Direct financial reward- increased payment Percent of fees PMPM or other payment increase for health plans Specify monthly ranging from $0 to $4.50 PMPM Upper reward limit $4.50 PMPM 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 Incremental goals - improvement over previous reporting period Pay for improvement of one measure/group of measures Relative goals Relative ranking to peer group on each measure Relative ranking to peer group on total score Relative ranking to peer group on efficiency Time lag between measurement and receiving reward/penalty Greater than six months Source of financial payments for meeting performance goals Current budget redistributed COLLABORATION CHARACTERISTICS Phases of program where sought target collaboration Program design and creation Program operations Characteristics of pre-implementation target feedback Provider participation in program design Cost of compliance per target group considered by sponsor Receives compensation for administrative burden of data collection No Characteristics of post-implementation target feedback Incentive target groups/individuals given comparative information Information provided on how results will be used Process available for target to provide additional information and/or corrections Blinding of performance feedback with targets Results disclosed with comparison to benchmarks Frequency of performance feedback to the targets Annually PROGRAM EVALUATION How the program evaluates its success An evaluation is not currently being conducted Lessons learned from designing and implementing the program Data has to be very clean.

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