June 22 2005
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Quality & Service Recognition Program A PPO Incentive Program for Quality Richard S. Chung, MD SVP, Health Services Division BCBS of Hawaii (Hawaii Medical Service Association). June 22, 2005. Low Risk. Moderate Risk. High Risk. Acute Condition. Chronic Disease. Catastrophic Illness.

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June 22, 2005

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June 22 2005

Quality & Service Recognition ProgramA PPO Incentive Program for QualityRichard S. Chung, MDSVP, Health Services DivisionBCBS of Hawaii(Hawaii Medical Service Association)

June 22, 2005


Quality service recognition program a ppo incentive program for quality richard s chung md svp health services divi

Low

Risk

Moderate

Risk

High

Risk

Acute

Condition

Chronic

Disease

Catastrophic

Illness

Role of Incentives in Healthcare Management

Primary Prevention Secondary Prevention Tertiary Prevention

Health Promotion

Preventive Care

Self-Care

Disease Management

Care Management/Utilization Management

Performance Management: QSR, EMR, E-Rx, EHR., etc.


Quality service recognition program a ppo incentive program for quality richard s chung md svp health services divi

PPO Program Design Issues


Quality service recognition program a ppo incentive program for quality richard s chung md svp health services divi

Design Issues SolutionPatient Centric Analysis


Qsr distribution of points

Practitioner Quality & Service Recognition Program

QSR Distribution of Points

  • Quality Indicators Maximum 40 points

    A. Clinical Measures (25)

    B. Member Rating (10)

    C. Board Certification ( 5)

  • Patient Satisfaction Maximum 30 points

  • Business Operations w/HMSA Maximum 15 points

    A. Hawaii Healthcare Information

    Network (HHIN) participation ( 5)

    B. Electronic Media Claims

    (EMC) participation ( 5)

    C. Lines of Business with HMSA ( 5)

  • Practice Patterns Maximum 15 points

    A. Medical Utilization Report ( 5)

    B. Formulary Compliance Report (10)


Quality service recognition program a ppo incentive program for quality richard s chung md svp health services divi

Base & BonusMonetary Awards

Practitioner Quality & Service Recognition Program

  • Maximum Base Award = $16,000

    • 1.5% -7.5% of the paid professional fees

    • For Scores <5%, Maximum award of $13,000

    • Minimum $100 for participation

  • Improvement Bonus Awards (20% of Ttl QSR Budget)

    • Clinical Measure (70+ measures)

    • Member Rating for Outcomes

    • Member Rating for Satisfaction

    • Rural Hospital Privileges/On-Call

    • Electronic Prescribing Technology

    • Generic Prescribing Rate Above the Mean

  • Overall, a maximum of $24,000 in Base & Bonus awards can be earned by an individual practitioner.


Quality service recognition program a ppo incentive program for quality richard s chung md svp health services divi

Award Payment Summary1998 - 2004

Practitioner Quality & Service Recognition Program

19982004

Total Awards=$2,165,197$10,650,000

# of Participants=8552,243

Mean Award=$2,532$4,744

Median Award=$1,946$3,565

# of Min Awards=45177

($150)($100)

# of Max Awards=1440

(14 @ $13,000)

(26 @ $16,000)


Quality service recognition program a ppo incentive program for quality richard s chung md svp health services divi

PPO2004

73.7%


Quality service recognition program a ppo incentive program for quality richard s chung md svp health services divi

Individual Measure

Logistic Regression Analysis

Practitioner Quality & Service Recognition Program

After PQSR program implementation, members were more likely to receive recommended care if they visited a QSRparticipating physician:

MeasurePercent Greater Likelihood of Receiving Specified Care

Breast Cancer Screening42 %

Cervical Cancer Screening52 %

Colorectal Cancer Screening13 %

ACE Inhibitor Use in CHF51 %

Diabetic Retinal Exam38 %

Annual HbA1c16 %

Use of Long Term Asthma Control Drugs -17 %*

Compliance with Antihypertensives -1 %*

Compliance with Lipid Lowering Drugs 7 %*

MMR Vaccinations -6 %*

VZV Vaccinations14 %*

Complications Following Cataract Surgery51 %*

*Result not statistically significant


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