PROGRAM SPONSORSHIP |
Formal name of the incentive and/or reward program initiative (if applicable) |
| Program name |
Primary Care Physician Incentive Program |
Program sponsor(s) and parent organization of sponsor(s), if applicable |
| Program sponsor(s) |
Paramount Health Care |
| Parent organization |
ProMedica Health System |
Primary program contact information |
| Name |
Marcia Kasza |
| Title |
Senior Project Coordinator |
| Organization |
Paramount Health Care |
| Email |
marcia.kasza@promedica.org |
| Phone |
419.887.2853 |
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 |
| 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 |
| Program operations cost |
0 |
Start date & end date of the program |
| Start Date |
01/01/1991 |
| End |
ongoing |
PROGRAM PERFORMANCE MEASURES
|
Outpatient clinical and safety measures included in the program |
| Measure sources |
| HEDIS (clinical components) |
|
|
Measurement areas |
| Other measurement areas |
| Diabetes |
|
| Pediatric Preventive Care |
|
|
Resource Utilization and Cost |
| Resource utilization |
| Emergency room (ER) visits |
|
| Pharmaceutical usage- prescriptions per patient visit rate |
|
|
| Cost |
| Total cost in Episode Treatment Groups (ETGs) |
|
|
Consumer measures |
| Additional details about your incentive/reward performance measurement mix |
will send as a separate document |
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) |
|
| Medical record data |
|
|
| Data extracting entity |
|
| Data aggregator/analyzer |
|
| Ensures data accuracy |
Yes |
| Means of ensuring accuracy |
| Other |
| Specify |
audits are in place within the department that extracts and formulates the data |
|
|
| Risk-adjustment mechanisms used |
| Adjustment for clinical risk factors |
| Specify methodology |
Medstat |
|
|
INCENTIVE/REWARD CHARACTERISTICS
|
Start date & end date of the incentive/reward |
| Start Date |
01/01/1991 |
| End Date |
ongoing |
Structure of the incentive or reward |
| Direct financial reward- increased payment |
|
| Upper reward limit |
3.00 pmpm |
Scoring used to determine payment |
| Absolute goals- patient level measures |
| Pay for meeting specific sub goals related to overall measure/group of measures |
|
|
| Relative goals |
| Other |
| Specify |
ranking to peer group cost measures and patient satisfaction measures |
|
|
| Frequency of reward or penalty |
|
| Time lag between measurement and receiving reward/penalty |
|
| Total dollar amounts awarded during the most recent calendar year |
$900,000.00 |
| Source of financial payments for meeting performance goals |
| Current budget redistributed |
|
|
COLLABORATION CHARACTERISTICS
|
| Phases of program where sought target collaboration |
| Program design and creation |
|
|
| Characteristics of pre-implementation target feedback |
| Provider participation in program design |
|
|
| 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 |
|
| 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 |
|
