2017 Physician Incentive Program by Payer

Transcription

1 2017 Physician Incentive Program by Payer BCN Commercial Payout Summary TARGET AMOUNT per SERVICE Breast screening 80%+ $125^ Childhood immunizations ( % of who children who turn 2 in Flat fee $50 the measurement year who received 2 influenza vaccines before the 2 nd birthday) Childhood Well Visits (% of children with 6 or more well child 89%+ ^ visits in the first 15 months of life) Pediatric Obesity BMI (% of children 3-17 with BMI claim) 83%+ $50^ Pediatric Obesity Counseling for Nutrition (% of children 3-17 with counseling reflected on claim, electronic data 78%+ $75^ submission, or entered in Health-e-Blue) Pediatric Obesity Counseling for Physical Activity (% of children 3-17 with counseling reflected on claim, electronic 63%+ ^ data submission, or entered in Health-e-Blue) Comprehensive diabetes care: HbA1c < 8% 66%+ $250^ Comprehensive diabetes care: monitoring for nephropathy 93%+ $150^ Depression management (PHQ9 testing in members over 12 Flat fee $200^ years old with a score of = or greater than 10 and had a PHQ9 during the f/u period with scoring below 5 or a 50% reduction from the original score) Diabetic Eye Exam N/A $25 flat fee Low Back Pain Imaging (% of patients with a dx of LBP who 83% or lower $150^ did NOT have study w/i 28 days of the dx) ADHD (% of members age 6-12 with an ambulatory 47%+ ^ prescription for ADHD medication who had a /u visit with practitioner during 30 day initiation phase) ^ Incentive money paid per patient if target is achieved

2 Blue Cross Complete (Medicaid)* BMI (Adult) $50 Diabetes: HbA1c test completed $25 Diabetes: A1c < 8.0% Comorbid condition (CHF DM CKD HTN) on ACE/ARB $40 target to be announced Well visit (20 and older) $20 BP control: 1)BP<140/90 for age )BP<140/90 for DM age $80 target to be announced 3)BP<150/90 for age (non-diabetic) Cervical Cancer Screening $30 Chlamydia Screening (female) $30 Chlamydia Screening (male) $30 Well visits at age NB, 2m, 4m, 6m, 9m, 12m, 15m (with 6 or more well visits before 15 mo Well visits at age 3-6 (% between age 3 and 6 yrs w/ 1 or more well $50 visits) Combo 3 (childhood immunization) $50 Adolescent Well Visit (12 to 21 years old) $50 Pediatric Obesity BMI (% of children 3-17 with BMI claim) $50 Lead Screening (prior to second birthday)

3 Priority Payout Summary* Commercial Medicare Advantage TARGET AMOUNT per SERVICE TARGET AMOUNT per SERVICE BMI 96% $0.10^ PMPM if 96% Comprehensive diabetic care (Controlled HbA1C <7 or 8 depending on age, Retinal eye exam, nephropathy monitoring, controlled BP) 20 to 29% 30 to 34% 35% + $75^ $125^ $200^ Diabetes: A1c < 7.0% 46% + $25^ - - Diabetes: A1c < 8.0% 70% + $30^ 78% + $30^ Diabetes: A1c < 9% 81% + $25^ 88% + $25^ Diabetes: Retinal eye exam 74% + $15^ 83%+ $15^ Diabetes: Nephropathy 94% + $10^ 98%+ $10^ Chronic Disease: # of the following measures above target rate: colorectal Ca (81%) A1c < 9% (88%) Eye Exam (83%) Nephropathy (98%) Controlling HTN (84%) 3 measures: $.25PMPM 4 measures: $.75PMPM 5 measures: $1.50PMPM Depression screening (PHQ2, PHQ4, 80%+.20 PMPM^ 80%.20 PMPM^ PHQ9 during an E/M visit) BP control: 1)BP<140/90 for age %+ $50^ 84% $50^ 2)BP<140/90 for DM age )BP<150/90 for age (non-diabetic) Cervical Cancer Screening 84%+ $10^ - - Colorectal Screening 76%+ $10^ 81%+ $10^ Chlamydia Screening 63%+ $10^ - - Well visits at age NB, 2m, 4m, 6m, 9m, 90%+ $75^ m, 15m (6 th visit) Well visits at age 3-6 (yearly) 88%+ $60^ - - Combo 3 (childhood immunization) 87%+ $170^ - Combo 2 (adolescent immunization) 26%+ $50^ - Lead Screening (prior to second birthday) 86%+ $15^ - Senior Care Education: Discussion of the following topics at a Wellness exam or CPE: 1. Fall prevention 2. Bladder control 3. Mental health eval 4. Physical activity 5. Proper coding for risk adjustment ^ Incentive money paid per patient if target is achieved - $0.25 PMPM

4 United Health Care Community Plan (Medicaid)* Comprehensive diabetic care (A1C testing, Retinal eye exam and nephropathy monitoring Diabetes: A1c test performed $25 Diabetes: Retinal eye exam $25 Cervical Cancer Screening $30 Chlamydia Screening (female) $40 Chlamydia Screening (male) $40 Tobacco Cessation Counseling for ages 18 and older (3 components: 1. $5 Advising to quit 2. Discuss cessation meds 3. Discuss cessation strategy) Well visits at age NB, 2m, 4m, 6m, 9m, 12m, 15m (1 to 5 visits) $25 Well visits at age NB, 2m, 4m, 6m, 9m, 12m, 15m (6 visits) Well visits at age 3-6 (yearly) $25 4 DTaP $20 3 IPV $20 1 MMR $20 3 HiB $20 3 Hep B $20 1 VZV $20 4 PCV $20 Combo 3 (childhood immunization) Combo 10 (childhood immunization) Adolescent Well Visit (12 to 21 years old) $25 Lead Screening (prior to second birthday) $50 Developmental Screening (Age 0 3 years, codes or 96111) $10 Asthma Appropriate Medications (Age 5 85 years, remained on $50 controller medication during %50 of the treatment period)

5 Total Health Care P4P Payout Diabetes: Retinal Eye Exam (Commercial and Medicaid) Cervical Cancer Screening (Commercial and Medicaid) Colorectal Screening (Commercial and Medicaid) Chlamydia Screening (females and males) (Commercial and Medicaid) per patient Well visits at age NB, 2m, 4m, 6m, 9m, 12m, 15m (6 visits) (Commercial and Medicaid) Combo 10 (childhood immunization) (Commercial and Medicaid) per patient $300 per patient Combo 2 (adolescent immunization) (Commercial and Medicaid)

6 Molina (Medicaid) Asthma Appropriate Medications (Age 5 85 years, remained on $50 controller medication during %50 of the treatment period) Comprehensive diabetic care (A1C testing, Retinal eye exam and nephropathy monitoring Diabetes: A1c test performed $25 Diabetes: A1c < 8.0% Diabetes: Retinal eye exam $25 Cervical Cancer Screening $25 Chlamydia Screening (female) $25 Initial adult visit with PCP and health risk assessment (age 19-64) $25 Pediatric Obesity (All 3 elements, BMI, physical activity and nutritional $15 counseling) Pharyngitis: Testing and treatment of pharyngitis (age 3-18) $25 Well visits at age NB, 2m, 4m, 6m, 9m, 12m, 15m (1 to 5 visits) $50 Well visits at age NB, 2m, 4m, 6m, 9m, 12m, 15m (6 visits) Well visits at age 3-6 (yearly) $50 4 DTaP $20 3 IPV $20 1 MMR $20 3 HiB $20 3 Hep B $20 1 VZV $20 4 PCV $20 1 Hep A $20 2 or 3 RV $20 2 Flu $20 Combo 3 (childhood immunization) Adolescent Well Visit (12 to 21 years old) $50 Lead Screening (prior to second birthday) $50

7 Meridian (Medicaid) BMI (Adult and peds) $5 Comprehensive diabetic care (A1C testing, Retinal eye exam and nephropathy monitoring Diabetes: A1c test performed $25 Diabetes: A1c < 8.0% $50 Diabetes: Retinal eye exam $25 Comprehensive diabetic care (Controlled HbA1C <7 or 8 depending on age, Retinal eye exam and nephropathy monitoring) Diabetes: Controlled BP (less than 140/90) and controlled HbA1C(less than 8) Cervical Cancer Screening $25 Chlamydia Screening (female) $35 Well visits at age NB, 2m, 4m, 6m, 9m, 12m, 15m (1 to 5 visits) $25 Well visits at age NB, 2m, 4m, 6m, 9m, 12m, 15m (6 visits) Well visits at age 3-6 (yearly) $25 4 DTaP $20 3 IPV $20 1 MMR $20 3 HiB $20 3 Hep B $20 1 VZV $20 4 PCV $20 1 Hep A $20 2 or 3 RV $20 2 Flu $20 Combo 3 (childhood immunization) Adolescent Well Visit (12 to 21 years old) $25 Lead Screening (prior to second birthday) $25