Record Detail

PROGRAM SPONSORSHIP Formal name of the incentive and/or reward program initiative (if applicable) Program name Performance-Based Contracting - MCO Pay for Performance Program Program sponsor(s) and parent organization of sponsor(s), if applicable Program sponsor(s) PA Department of Public Welfare Primary program contact information Name Laurie Rock Title Director, Division of Quality and Special Needs Coordination Organization PA Department of Public Welfare Email LRock@state.pa.us Phone 717-772-6193 Sponsoring organization type Government(s) State Specify Pennsylvania Source of funding associated with program set-up costs Funding source Other Specify Funded by PA Medicaid (also receives FFP) Percent contributed by sponsor and grant organization % Sponsor 100% Program set-up costs 75000 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 190000 Start date & end date of the program Start Date 01/01/2005 End "ongoing"   PROGRAM SCOPE Geographic scope of program Pennsylvania Individuals affected by program as a percentage of total population, if known Medicaid (indicate %) 100% in capitated managed care 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) Medicaid Other Specify Medicaid Managed Care Plans Recruitment of program targets Mandatory- all members of the target group must participate (e.g. part of contracting) PROGRAM PERFORMANCE MEASURES Health plan performance measures Health plan measures HEDIS scores Other Specify State developed performance measures Performance measure weighting Clinical performance % or N/A 100% Consumer measures Additional details about your incentive/reward performance measurement mix Measure / Description Controlling High Blood Pressure The percentage of members 18 to 85 years of age who had a diagnosis of high blood pressure and whose blood pressure was adequately controlled. Comprehensive Diabetes Care: HbA1c Poorly Controlled The percentage of members 18 to 75 years of age with poorly controlled diabetes. Comprehensive Diabetes Care: LDL Control 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 Other Specify Both Managed Care Organization and Program target apply. Data aggregator/analyzer Other Specify Both Managed Care Organization and Independent entity Ensures data accuracy Yes Means of ensuring accuracy Auditing Specify who audits and how often Annual HEDIS Audit Risk-adjustment mechanisms used None of the above INCENTIVE/REWARD CHARACTERISTICS Start date & end date of the incentive/reward Start Date 01/01/2007 End Date "ongoing" Structure of the incentive or reward Direct financial reward- increased payment PMPM or other payment increase for health plans Specify Can earn up to 0.5% PMPM (will increase to 2.5% in State Fiscal Year 07-08) Indirect financial reward Publicize good performance Target audience for publication of performance To consumers To plans Direct financial penalty Other Specify Will not earn increased PMPM Upper reward limit 0.5% of PMPM for CY 2005 = $10,621,577.00 and for CY 2006 = $20,732,756.00 Scoring used to determine payment Incremental goals - improvement over previous reporting period Pay for improvement of one measure/group of measures Pay for improvement of each measure Relative goals Relative ranking to peer group on each measure 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 $4,463,097.00 paid out in 2007 for care rendered in 2005. Source of financial payments for meeting performance goals New funding -internal Shared savings breakdown (percentage should add to 100) if applicable Additional details about the incentive/reward characteristics and scoring methodology A complete description of the program, goal setting and incentives can be found within the contract with our managed care organizations. A link to this language is provided below. http://www.dpw.state.pa.us/omap/hcmc/hcagr/pdf/HCStandAgreeExhibitB.pdf COLLABORATION CHARACTERISTICS Phases of program where sought target collaboration Program operations Receives compensation for administrative burden of data collection Yes Characteristics of post-implementation target feedback Incentive target given opportunity for full explanation of results before use Incentive target groups/individuals given comparative information Process available for target to provide additional information and/or corrections Blinding of performance feedback with targets Results disclosed with comparison to benchmarks Results to peers with names disclosed Frequency of performance feedback to the targets Semi-annual PROGRAM EVALUATION How the program evaluates its success Improvements in clinical performance Improvements in health status of population Evaluator Program sponsor Additional results of program evaluation The program started with 10 measures; however one was dropped due to unforeseen changes of the impact to the measurement’s technical specifications. Of the remaining 9 measures, all demonstrated improvement as compared to year prior to the introduction of the P4P program. Seven of 9 measures showed statistically significant improvement; however, we have not been able to link the improvement to the introduction of the Pay for Performance program. Lessons learned from designing and implementing the program 1. Using HEDIS® specifications can present problems when the specifications change from year to year. Particularly if you are trending data year to year. 2. Defining standardized goals and incentives that are fair to all plans in the program requires creativity and foresight.

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