Record Detail

PROGRAM SPONSORSHIP Formal name of the incentive and/or reward program initiative (if applicable) Program name Pennsylvania Department of Public Welfare ACCESS Plus Provider P4P Program Program sponsor(s) and parent organization of sponsor(s), if applicable Program sponsor(s) Pennsylvania Department of Public Welfare (DPW) Primary program contact information Name Jennifer Basom Title Director, Quality Management Organization Department of Public Welfare Email jbasom@state.pa.us Phone 717-772-6132 Sponsoring organization type Government(s) State Specify Pennsylvania--Department of Public Welfare 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 115200 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 172800 Start date & end date of the program Start Date 11/01/2005 End "ongoing"   PROGRAM SCOPE Geographic scope of program Pennsylvania Individuals affected by program as a percentage of total population, if known Medicaid (indicate %) 100% of the ACCESS Plus population inclusive of 288,000 covered lives in 42 counties Coverage of affected individuals (for purchaser sponsors only) Other Specify ACCESS Plus FFS Primary Care Case Management Program Plan product(s) the program applies to (for plan sponsors only) Other Specify ACCESS Plus FFS Primary Care Case Management Program Direct target(s) of your program's incentives/rewards Physician type PCPs Specialists Indicate the specialities Family Practice, Internal Medicine, Obstetrics & Gynecology Physician unit Individual physician/clinician, Medical group 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) Other Specify Appropriate prescription and patient use of chronic medications per clinical practice guidelines Measurement areas Cardiac Coronary artery disease (CAD) Other Specify Appropriate medication prescription and use Pulmonary Adult Asthma Pediatric Asthma Chronic obstructive pulmonary disease (COPD) Other Specify Appropriate medication prescription and use Other measurement areas Diabetes Health plan performance measures Performance measure weighting Clinical performance % or N/A 100% Consumer measures Additional details about your incentive/reward performance measurement mix Each provider is provided with a listing of high risk patients that are part of their practice who would benefit from participation in the ACCESS Plus Disease Management Program. Providers have four opportunities to be paid for their work in support of the program: 1) Endorse and support patient enrollment; 2) Agree to supply patient contact information; 3) Completion of a “Care Coordination Feedback Form”; and 4) Appropriate prescription and patient use of chronic medications. Please see additional information on the ACCESS Plus P4P Program located at: http://www.accessplus.org/PayForPerformance.aspx Data Reliability Sources of data Existing or new data Existing data sources Data type Administrative in origin (derived from claims data) Self-reported Data extracting entity Other Specify Contractor and Program target Data aggregator/analyzer Other Specify Contractor and Program sponsor Ensures data accuracy Yes Means of ensuring accuracy Self-attestation as to accuracy Specify who does the self-attestation, e.g. CEO Program target Other Specify Claims validation, defined data entry program for self-reported data Risk-adjustment mechanisms used None of the above INCENTIVE/REWARD CHARACTERISTICS Start date & end date of the incentive/reward Start Date 03/01/2006 End Date "ongoing" Structure of the incentive or reward Direct financial reward- increased payment Lump-sum bonus Upper reward limit 1) Endorse and support patient enrollment; $200 one time payment plus $40 per contacted patient Scoring used to determine payment Absolute goals- patient level measures Pay for meeting one overall measure/group of measures Other Pay for reporting Other Specify Note: Pay for reporting (Completion of Chronic Care Feedback Form) Frequency of reward or penalty Quarterly Time lag between measurement and receiving reward/penalty Three - six months Total dollar amounts awarded during the most recent calendar year $600,000 Source of financial payments for meeting performance goals New funding -internal Other Specify Paid through ACCESS Plus population PMPM 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 Yes Characteristics of post-implementation target feedback Information provided on how results will be used Mechanism to consider additional information and communicate back to target Process available for target to provide additional information and/or corrections Blinding of performance feedback with targets Confidential Frequency of performance feedback to the targets Quarterly PROGRAM EVALUATION How the program evaluates its success Improvements in clinical performance Improvements in health status of population Sponsor financial return on investment (ROI) Evaluator Program sponsor Independent entity Specify Contractor evaluated ROI for overall performance of the program Additional results of program evaluation The original P4P was designed to focus more on Pay for Participation. To date, over 800 physicians have signed on to participate in the program and DPW has paid over Six Hundred Thousand Dollars ($600,000) in incentives to such enrolled providers. We are currently in the process of doing a more formal assessment of the first program year. Lessons learned from designing and implementing the program Initially, achieving the desired level of provider participation was a challenge. We found that providers were hesitant to participate in the program due to an overall lack of understanding of the program. In addition, providers had concerns over administrative burden and payment efficiency. To assist in alleviating those concerns, provider education was provided to comprehensively detail DPW’s P4P. This education also focused on internal processes that were implemented to facilitate ease for providers in the capturing and reporting of relevant data to DPW as well as payment structure and methodology.

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