Record Detail

PROGRAM SPONSORSHIP Formal name of the incentive and/or reward program initiative (if applicable) Program name Physician Incentive Program Program sponsor(s) and parent organization of sponsor(s), if applicable Program sponsor(s) Priority Health Primary program contact information Name Todd Osbeck Title Senior Manager, Quality Improvement Organization Priority Health Email todd.osbeck@priority-health.com Phone (616) 464-8567 Sponsoring organization type Health Plan(s) Single HMO Source of funding associated with program set-up costs Funding source Other Percent contributed by sponsor and grant organization Program set-up costs 0 Source of funding associated with program operations costs Funding source Other Percent contributed by sponsor and by grant organization Program operations cost 0 Start date & end date of the program Start Date 6/5/1997 End ongoing   PROGRAM SCOPE Geographic scope of program Michigan Individuals affected by program as a percentage of total population, if known Employer/commercial health plan- active workers Employer/commercial health plan- dependents Plan product(s) the program applies to (for plan sponsors only) HMO Direct target(s) of your program's incentives/rewards Physician type PCPs Consumers- health plan enrollees (for health plan respondents only) HMO HMO/POS Recruitment of program targets Mandatory- all members of target group that meet certain criteria Specify Minimum total patient/enrollee volume; 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 HEDIS (clinical components) Other Specify Evidence-based medicine clinical measures developed internally or by consultants; Patient surveys from any source including CAHPS Measurement areas Cancer screening Breast Cervical Pulmonary Adult Asthma Pediatric Asthma Other measurement areas Diabetes Adult Preventive Care Pediatric Preventive Care Other Specify Chlamydia Screening Patient-Centeredness Patient-centeredness measures Patient-centeredness performance measure sources HEDIS (non-clinical component) Ambulatory CAHPS Resource Utilization and Cost Resource utilization Diagnostic imaging- radiology Emergency room (ER) visits Health plan performance measures Health plan measures HEDIS scores CAHPS scores Performance measure weighting Clinical performance % or N/A 50 Safety % or N/A 5 HIT adoption % or N/A 5 Cost % or N/A 40 Consumer measures Enrollment and/or participation in risk reduction program Health risk appraisals Other Specify Complete preventive health guideline recommendations Data Reliability Sources of data Existing or new data New data collected explicitly for program reporting Data type Administrative in origin (derived from claims data) Medical record data Data extracting entity Other Data aggregator/analyzer Program sponsor Ensures data accuracy Yes Means of ensuring accuracy Auditing Specify who audits and how often On an as need basis, Priority Health conducts a formal data integrity rveiw process where internally the organization investigats all physician inquiries regarding PIP measurement results. Each inquiry is logged, investigated and resolved. The resolution INCENTIVE/REWARD CHARACTERISTICS Start date & end date of the incentive/reward Start Date 06/05/1997 End Date ongoing Structure of the incentive or reward Direct financial reward- increased payment Lump-sum bonus PMPM or other payment increase for health plans Specify Certain measures (tobacco use screening, BMI screening, electronic health record adoption, patent satisfaction, and accesss) reward physicians on a per member per month basis. Indirect financial reward Publicize good performance Target audience for publication of performance To consumers To provider peers Indirect financial penalty Publicize poor performance Target audience for publication of performance results (check all that apply) Target audience for publication of performance To consumers To provider peers Scoring used to determine payment Absolute goals- patient level measures Pay for meeting one overall measure/group of measures Absolute goals- population level measures Pay for meeting one overall measure/group of measures Frequency of reward or penalty Annually Time lag between measurement and receiving reward/penalty Greater than six months Total dollar amounts awarded during the most recent calendar year $6,558,000 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 Receives compensation for administrative burden of data collection No Blinding of performance feedback with targets Full public reporting Frequency of performance feedback to the targets Other Specify Real-time feedback PROGRAM EVALUATION How the program evaluates its success Sponsor financial return on investment (ROI) Other types of evaluation Specify HEDIS Quality and Overall Performance; National rankings Evaluator Independent entity Specify NCQA Additional results of program evaluation Priority Health annually evaluates the return on investment for each of its health management programs (diabetes, asthma, etc.). Priority Health’s HEDIS results for the quality measures included in PIP improved on average 7 points in 2004 and 6 points in 2005. Additionally Priority Health’s overall HEDIS performance rose 3.5 percentage points effectively doubling our rate of improvement for the last two consecutive years. This has resulted in Priority Health ranking among the top 5% of all health plans nationally in 2006 according to U.S. News and World Report.

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