PROGRAM SPONSORSHIP |
Formal name of the incentive and/or reward program initiative (if applicable) |
| Program name |
Aetna - Bridges to Excellence participation |
Program sponsor(s) and parent organization of sponsor(s), if applicable |
| Program sponsor(s) |
Georgia: UPS, Xerox, Southern Company, Choice Point
North Carolina: GSK, Wachovia
Cincinatti and Lousiville: UPS
D.C. Metro area: All plan sponsors
Seattle: All plan sponsors |
Primary program contact information |
| Name |
Bill Stout |
| Title |
Network Market Head |
| Organization |
Aetna |
| Email |
StoutB@Aetna.com |
| Phone |
412-875-7837 |
Sponsoring organization type |
| Employer(s) |
Single employer, Multiple employers |
| Multiple Sponsors |
| Employer/health plan coalition |
|
|
| Health Plan(s) |
Single HMO, Single PPO/other, Multiple health plans |
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 |
01/01/2004 |
| End |
ongoing |
PROGRAM SCOPE |
| Geographic scope of program |
Washington |
| Individuals affected by program as a percentage of total population, if known |
| Employer/commercial health plan- active workers |
|
| Employer/commercial health plan- dependents |
|
|
| Coverage of affected individuals (for purchaser sponsors only) |
| HMO |
|
| HMO/POS |
|
| PPO |
|
| Consumer-Driven Health Plan (CDHP) |
|
| Other |
|
|
Direct target(s) of your program's incentives/rewards |
| Physician type |
| PCPs |
|
| Specialists |
| Indicate the specialities |
Family Practice, Internal Medicine |
|
|
| Physician unit |
Individual physician/clinician |
| Consumers- health plan enrollees (for health plan respondents only) |
| HMO |
|
| HMO/POS |
|
| PPO |
|
| Consumer-Driven Heath Plan (CDHP) |
|
| Medicare |
|
|
| Recruitment of program targets |
| Voluntary with financial or non-financial penalty for non-participation |
|
| Voluntary with no penalty for non-participation |
|
|
PROGRAM PERFORMANCE MEASURES
|
Outpatient clinical and safety measures included in the program |
| Measure sources |
|
Measurement areas |
| Cardiac |
| Coronary artery disease (CAD) |
|
|
| Other measurement areas |
|
Health information technology adoption measures |
| Adoption of outpatient HIT |
| Patient tracking (e.g., managing patient data) |
|
| Registry functions tracking (e.g., clinical data repository) |
|
| Clinical documentation |
|
| Decision support (e.g., alerts, reminders or point-of-care guidelines) |
|
|
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 |
|
| Self-reported |
|
|
| Data extracting entity |
|
| Data aggregator/analyzer |
|
| Ensures data accuracy |
Yes |
| Means of ensuring accuracy |
| Auditing |
| Specify who audits and how often |
NCQA |
|
|
| Risk-adjustment mechanisms used |
|
INCENTIVE/REWARD CHARACTERISTICS
|
Start date & end date of the incentive/reward |
| Start Date |
10/01/2007 |
| End Date |
ongoing |
Structure of the incentive or reward |
| Direct financial reward- increased payment |
|
| Indirect financial reward |
| Publicize good performance |
|
|
| Target audience for publication of performance |
| To consumers |
|
| To provider peers |
|
| To purchasers |
|
|
| Upper reward limit |
$20K/doc/year; $50k lifetime |
Structure of the incentive or reward for programs targeted at consumers |
| Financial reward - direct |
| Cash reward or reward of monetary value |
| Specify dollar amount |
61-100 |
|
|
Scoring used to determine payment |
| Absolute goals- patient level measures |
| Pay for meeting specific sub goals related to overall measure/group of measures |
|
|
| Frequency of reward or penalty |
|
| Time lag between measurement and receiving reward/penalty |
| One - three months |
|
| Three - six months |
|
| Greater than six months |
|
|
| Source of financial payments for meeting performance goals |
| Current budget redistributed |
|
|
Shared savings breakdown (percentage should add to 100) if applicable |
| Additional details about the incentive/reward characteristics and scoring methodology |
Annual bonus based on physician's NCQA-recognized anniversary date, some sites lagged up to a year some not. |
