Record Detail

PROGRAM SPONSORSHIP Formal name of the incentive and/or reward program initiative (if applicable) Program name Distinctions (sm) Program sponsor(s) and parent organization of sponsor(s), if applicable Program sponsor(s) Babette Apland, Senior Vice President, Health and Care Management Parent organization HealthPartners Primary program contact information Name Rita Murtada, Ph.D. Title Sr. Director, Provider Relations and Contracting Organization HealthPartners Email Rita.G.Murtada@HealthPartners.com Phone 952-883-5604 Sponsoring organization type Health Plan(s) Single HMO, Single PPO/other 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 300000 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 250000 Start date & end date of the program Start Date 07/01/2003 End Ongoing   PROGRAM SCOPE Geographic scope of program Minnesota, North Dakota, South Dakota Individuals affected by program as a percentage of total population, if known Employer/commercial health plan- active workers (indicate %) 50% Employer/commercial health plan- dependents (indicate %) 50% Coverage of affected individuals (for purchaser sponsors only) HMO HMO/POS PPO Consumer-Driven Health Plan (CDHP) Plan product(s) the program applies to (for plan sponsors only) HMO HMO/POS PPO Consumer-Driven Health Plan (CDHP) Direct target(s) of your program's incentives/rewards Hospital type General Specialty- Cardiac Specialty- Orthopedic Specialty- Surgical Specialty- Women's Academic hospital(s)- American Association of Medical Colleges (AAMC) member(s) Other Specify Additional physician specialties: ENT, Cardiology Hospital unit Individual Physician type PCPs Specialists Indicate the specialities Family Practice, Geriatric Medicine, Internal Medicine, Obstetrics & Gynecology, Orthopedic Surgery Physician unit Medical group Consumers- employer covered lives (for employer respondents only) Other Specify N/A Consumers- health plan enrollees (for health plan respondents only) HMO HMO/POS PPO Consumer-Driven Heath Plan (CDHP) Health plans (for employers that reward plans only) Other Specify N/A Recruitment of program targets Mandatory- all members of the target group must participate (e.g. part of contracting) PROGRAM PERFORMANCE MEASURES Clinical/Safety Performance Inpatient clinical and safety measures included in your program Measure sources JCAHO Core Measures The Leapfrog Group Quality and Safety Measures (NQF-endorsed Safe Practices for Better Healthcare) Measure areas Cardiac Acute myocardial infarction (AMI) Congestive heart failure (CHF) Coronary artery bypass graft (CABG) surgery Percutaneous coronary interventions (PCI) Cancer Other Specify N/A Neurosurgery/Neurology Other Specify N/A Obstetrics-Gynecology Other Specify Patient Experience Measures Orthopedics Other Specify N/A Pulmonary Community-acquired pneumonia (CAP) Safety Adverse drug event rate NQF's 27 hospital safe practices (Leapfrog) Evidence-based hospital referral (Leapfrog) ICU staffing (e.g., intensivists) (Leapfrog) Other Specify Comp. Physician Order Entry Other measurement areas Timely Care: Avoiding delays; OB Care: Neonatal Intensive Care and Managing Pain; Surgical Care: Repairing Aortic Aneurysm; Medical Care: Managing Pain, Help to Quit Smoking, Advice on Exercise, Advice on Healthy Eating, Advice on Healthy Weight Outpatient clinical and safety measures included in the program Measure sources Bridges to Excellence HEDIS (clinical components) Measurement areas Cardiac Coronary artery disease (CAD) Other Specify Heart Failure, Heart Attach, Avoiding Delays Cancer screening Breast Cervical Colon Pulmonary Adult Asthma Pediatric Asthma Community-acquired pneumonia (CAP) Safety Other Specify Explain Medications; Explain Side Effects of Medications, EMR Implementation, Minnesota Immunization Information Connection Registry Participation Other measurement areas Diabetes Hypertension Mental health/substance abuse Adult Preventive Care Pediatric Preventive Care Other Specify Healthy Lifestyles; Back Pain; Sore Throat and Cold Health information technology adoption measures Adoption of inpatient HIT CPOE Patient tracking (e.g., managing patient data) Adoption of outpatient HIT Patient tracking (e.g., managing patient data) Registry functions tracking (e.g., clinical data repository) Ambulatory CPOE (ACPOE) E-prescribing   Measures in development Patient-Centeredness Patient-centeredness measures Patient-centeredness performance measure sources HEDIS (non-clinical component) Other Specify Medical or Surgical Patient Experience and OB Patient Experience: How Well Nurse Listens, Explanation About Tests or Procedures, How Well Staff Works Together, Addressing Your Concerns, Keeping You Informed, Keeping Your Doctor Informed, Prepared for Dis Resource Utilization and Cost Resource utilization Pharmaceutical usage- generic usage rate Other Specify Longitudinal Efficiency Based on Episodes of Care Cost Total cost in Episode Treatment Groups (ETGs) Other Specify DRGs, APCs, RVUs Health plan performance measures Health plan measures Other Specify N/A Performance measure weighting Clinical performance % or N/A Hospitals: 33% - separately measured to obtain preferred tier; Professionals: 60% - separately measured to obtain preferred tier Safety % or N/A Hospitals: 33% - Separately measured to obtain preferred tier; Professionals: 10% - separately measured to obtain preferred tier HIT adoption % or N/A Professionals: 10% - separately measured to obtain preferred tier Patient-centeredness (i.e. HCAHPS) % or N/A Hospitals: 33% - separately measured to obtain preferred tier; Professionals: 20% - separately measured to obtain preferred tier Resource utilization % or N/A 100% for Hospital, Specialties and Primary Care Consumer measures Enrollment and/or participation in risk reduction program Other Specify N/A Enrollment and/or participation in risk management program Other Specify N/A Enrollment in high-value health plan Other Specify N/A Provider choice Chooses high-performing physicians, Chooses high-performing hospital 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 Self-reported Other Specify Member Experience Surveys Data extracting entity Other Specify Independent entity, program target, and internal Health Informatics Resources Data aggregator/analyzer Other Specify Independent entity, program target, and internal Health Informatics Resources Ensures data accuracy Yes Means of ensuring accuracy Auditing Specify who audits and how often Annual external auditor for HEDIS measurement Self-attestation as to accuracy Specify who does the self-attestation, e.g. CEO Medical Director review, nurse review, Informatics review, external expert forums Other Specify External Expert Forums Risk-adjustment mechanisms used Adjustment for clinical risk factors Specify methodology ACG Risk Adjustment, Outlier Mechanisms, Adjustment for Specialty, Person Centered Outliers, Adjustment for Age, Complications Adjustment for socio-economic factors Specify methodology Choose to Lmiit to Commercial Population INCENTIVE/REWARD CHARACTERISTICS Start date & end date of the incentive/reward Start Date 07/01/2003 End Date Ongoing Structure of the incentive or reward Direct financial reward- increased payment Other Specify Does not apply Indirect financial reward Co-pay/coinsurance/and/or deductible reduction to consumers to potentially increase volume/enrollment (e.g., tiering, Center of Excellence) Publicize good performance Target audience for publication of performance To consumers To provider peers To purchasers Direct financial penalty Other Specify Does not apply 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 To purchasers Non-financial reward Other Specify Does not apply Structure of the incentive or reward for programs targeted at consumers Financial reward - direct Co-pay/coinsurance/and/or deductible reduction Financial penalty - direct Co-pay/coinsurance/and/or deductible increase (tiering) Average monetary consumer incentive HealthPartners requires a $10 co-pay or 10% coinsurance differential between tiers. Scoring used to determine payment Relative goals Relative ranking to peer group on each measure Relative ranking to peer group on total score Relative ranking to peer group on efficiency 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 Does not apply Source of financial payments for meeting performance goals Other Specify Does not apply Shared savings breakdown (percentage should add to 100) if applicable Additional details about the incentive/reward characteristics and scoring methodology HealthPartners tiering program is cost and quality-based. A provider cannot become a tier one provider simply by maintaining lower costs, they must also excel in providing quality care. To be in Distinctions (sm) preferred tier, a provider must perform above average in quality (composite of 80+ quality metrics) and be below average in cost. HealthPartners website provides comparative quality ratings for providers which assists the member in selecting a provider with high quality performance. HealthPartners tiering approach provides the best of both words for members. By requiring providers in the preferred tier to excel in both quality and cost, members can make their selection based on the criteria most important to them, while simultaneously insuring that they receive both high quality and cost effective care. 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 Other Specify Solicit feedback from employer groups who utilize this option 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 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 Results disclosed with comparison to benchmarks Results to peers with names disclosed Full public reporting Frequency of performance feedback to the targets Quarterly Semi-annual Annually Other Specify The frequency of feedback is measure dependent. PROGRAM EVALUATION How the program evaluates its success Improvements in clinical performance Improvements in health status of population Sponsor financial return on investment (ROI) Other types of evaluation Specify Employer-based Return on Investment Evaluator Program sponsor Independent entity Specify The Minnesota Medical Association acted on the behalf of the local provider community to evaluate Minnesota Health plabn tiering methodologies. HealthPartners reviewed and considered their findings and final evaluation and used this reference document to Additional results of program evaluation Cost savings are achieved but are variable dependent upon employer group specific benefit designs. Lessons learned from designing and implementing the program Using a tiered provider network is first and foremost a benefit option to help consumers understand the financial and quality impacts of the health care choices they make. Therefore, it is important to focus on tiering in a way that has the most meaning to consumers. Following are some lessons we learned through this process:  It is crucial to tier providers based on the use of quality as well as cost data;  Tier first in areas that have the greatest use such as hospitals, primary care, and high use specialties;  Cost analysis is more straight forward than quality analysis;  Use quality measures that are representative of a core of what care a pparticular type of provider offers to consumers;  Look at both cost and quality data and do not favor one over the other in determining the relative position of a provider compared with other like providers.

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