Obstetrical Pay For Performance

1. Obstetrical Pay For Performance

2. Introduction The Department of Social Services is introducing a Pay for Performance (P4P) Program in obstetrics care, beginning August 1, 2013. The purpose of this program is to improve the care for pregnant women and the outcomes of their newborns covered under the HUSKY Health programs. A total of $1.2 million was appropriated by the Connecticut General Assembly to be paid to providers of obstetric care in State Fiscal Year 2015. Obstetrical P4P payments are in addition to current fee for service payments.

3. Eligible Providers Providers eligible to participate in the obstetric P4P Program are providers currently enrolled as family medicine physicians, obstetrician/gynecologists, obstetric nurse practitioners, family medicine nurse practitioners, physician assistants and certified nurse midwives enrolled in the Connecticut Medical Assistance Program (CMAP) network and providing obstetric care to eligible Husky Health and Charter Oak Health Plan clients.

4. Performance Measures The following performance measures (with their associated point values) are those for which the Department will provide incentive payments:

5. Evaluating Provider Performance • Data on provider’s performance on the above measures will be collected from claims and from the obstetrics notification forms. • Only episodes of care for which providers use the online obstetrics notification forms will be eligible for the P4P Program.

6. Measure: Online OB Notification Form Question(s) Data CollectionOnline OB Notification Forms Points are awarded if the online OB notification is completed within 14 days of the first prenatal visit. Timely completion (within 14 days) of online obstetrics prenatal and post-partum notification forms

7. Data CollectionOnline OB Notification Forms Measure: Online OB Notification Form Question(s) At least one postpartum visit within 21 – 56 days after delivery Points awarded if a postpartum visit occurred within 21-56 days of the actual date of delivery

8. Measure: Online OB Notification Form Question(s) Data CollectionOnline OB Notification Forms Points awarded if the first prenatal visit date and the pregnancy confirmation date is within 14 days. A first obstetric visit within 14 days after confirmation of pregnancy

9. Data CollectionOnline OB Notification Forms Measure: Online OB Notification Form Question(s) Appropriate use of 17-alpha hydroxyprogesterone when there is prior history of singleton preterm labor Both claims and the above OB notification form questions will be utilized to award points for this measure.

10. Data CollectionOnline OB Notification Forms Measure: Note: 30 points subtracted from the provider’s total if NOT used when clinically indicated. Current ACOG guidelines for the use of 17-alpha hydroxyprogesterone will be used as a reference for this measure. Appropriate use of 17-alpha hydroxyprogesterone when there is prior history of singleton preterm labor

11. Data CollectionOnline OB Notification Forms Measure: Online OB Notification Form Question(s) Full-term, vaginal delivery after spontaneous labor whenever medically possible.

12. Accessing the Provider Portal & OB Notification Forms CLICK ON “For Providers”

13. Accessing the Provider Portal & OB Notification Forms CLICK ON

14. Please click on the icon below to access a “Provider Portal & OB Notification Form How To Guide”

15. Overview OB Notification Forms • There are two types of OB Notification Forms • Prenatal • Providers should complete this form online within 14 days of the member’s first prenatal visit. • Postpartum • Providers should complete this form online within 14 days of the member’s first postpartum visit. • Note: Interconception counseling should be a component of this PP visit.

16. Overview OB Notification Provider Resources Within the Prenatal OB form there are available evidence based resources for the provider to use with their patients.

17. OB Notification Form Questions Patient/Member Demographics

18. OB Notification Form QuestionsPregnancy History Enter the appropriate numerical answer

19. OB Notification Form QuestionsMember/Patient Contact and First Visit Enter the appropriate dates.

20. OB Notification Form QuestionsOB Provider Information & Hospital Enter the Primary (or Attending)Prenatal Provider’s Name Enter the name of the practice (This can be a clinic, private practice, group practice or FQHC)

21. OB Notification Form QuestionsSocial Needs Assessment & Risk Answer Yes or No Choose the appropriate drop down choice

22. OB Notification Form QuestionsRisk Identification Choose the appropriate drop down choice Note: The provider can identify up to 4 risk factors.

23. OB Notification Form QuestionsBehavioral Health Needs Answer Yes , No or Pt refused Choose the appropriate drop down choice Note: The provider can identify up to 4 risk factors.

24. OB Notification Form Questions17 –Hydroxyprogestrone Caproate Screening Answer Yes or No Answer Yes or No

25. OB Notification Form QuestionsMedications Please type in all of the patient/member’s current medications Note: The intensive care management team will use this information for medication reconciliation

26. Submitting the Form Enter the name of the person completing the form Submit Date auto populates to the date the form was completed & submitted Click on this button ( ) to submit the form. Note: This step must be done to submit the form

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