Record Detail

PROGRAM SPONSORSHIP Formal name of the incentive and/or reward program initiative (if applicable) Program name Provider HEDIS Bonus Program Program sponsor(s) and parent organization of sponsor(s), if applicable Program sponsor(s) Health Plan of Michigan Primary program contact information Name Raymond Pitera Title Director, Provider Services Organization Health Plan of Michigan Email rpitera@hpmich.com Phone (248) 204-6006 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 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 Michigan Individuals affected by program as a percentage of total population, if known Medicaid (indicate %) 100% 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 Physician type PCPs Physician unit Individual physician/clinician Recruitment of program targets Voluntary with no penalty for non-participation PROGRAM PERFORMANCE MEASURES Outpatient clinical and safety measures included in the program Measure sources HEDIS (clinical components) Measurement areas Cancer screening Breast Cervical Pulmonary Adult Asthma Other measurement areas Diabetes Prenatal care Adult Preventive Care Pediatric Preventive Care Health plan performance measures Health plan measures HEDIS scores Performance measure weighting Clinical performance % or N/A 100% Consumer measures Additional details about your incentive/reward performance measurement mix Health Plan of Michigan uses HEDIS measures as the basis for its provider bonus program. The following HEDIS measures are used: Childhood Immunizations Adolescent Immunizations Well Child Visits (0-15 Months) Well Child Visits (3-6 Years) Adolescent Well Care Visits Breast Cancer Screening Cervical Cancer Screening Chlamydia Screening Prenatal and Postpartum Care Comprehensive Diabetes Care Measures are subject to change each year, based on HPM priorities and State regulatory requirements. Data Reliability Sources of data Existing or new data Existing data sources 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 HEDIS Auditor - Annual Risk-adjustment mechanisms used None of the above INCENTIVE/REWARD CHARACTERISTICS Start date & end date of the incentive/reward Start Date 6/5/02 End Date Ongoing Structure of the incentive or reward Direct financial reward- increased payment Lump-sum bonus Upper reward limit Unlimited Scoring used to determine payment Absolute goals- patient 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 Three - six months Total dollar amounts awarded during the most recent calendar year $2.9 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 HPM elected to develop a reward structure that would be easy for providers to understand. The bonus is based on an additional payment for each HEDIS service that is rendered. Payments range from $15 for an immunization to $50 for a well child visit. Although members may receive care from multiple providers, the bonus is given to the PCP that the member is assigned to at the time of the bonus payment. Payments are made in a lump sum in three installments. The first two payments are made in May and October of the measurement year and the final payment is made in April of the following year (i.e. the HEDIS reporting year). This payment structure encourages providers to send in claims on a timely basis prior to the HEDIS reporting deadline. Payments are made based on strict HEDIS criteria, except that continuous enrollment is adjusted to assume continuous enrollment for the year, as long as the member has been continuously enrolled for the year to date, as of the date of the bonus payment. COLLABORATION CHARACTERISTICS Phases of program where sought target collaboration Program operations Receives compensation for administrative burden of data collection No Characteristics of post-implementation target feedback Incentive target given opportunity for full explanation of results before use 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 Monthly PROGRAM EVALUATION How the program evaluates its success Improvements in clinical performance Evaluator Program sponsor Additional results of program evaluation The measures and the dollar amounts paid for each measure have evolved over time. HPM tracks the amount paid to providers for its HEDIS bonus each year. HPM also measures the increase in rates for each of the HEDIS measures included in the bonus program. On average, the rates for the HEDIS measures included in the provider bonus program increased by 23 percentage points since the inception of the program. Lessons learned from designing and implementing the program We have found that providers appreciate the simplicity and transparency of this program and that the direct link between providing the necessary services and obtaining additional payment is a motivating factor for Medicaid providers.

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