1 / 7

CareFirst’s Pay for Quality Programs Jon Shematek, MD June 22, 2005

CareFirst’s Pay for Quality Programs Jon Shematek, MD June 22, 2005. Quality-Based Payment. Current program description Successes Future Directions Bridges to Excellence Pilot Consumer Impact. BlueChoice Primary Care Physician Recognition Program (PCPRP). Objective:

kalli
Download Presentation

CareFirst’s Pay for Quality Programs Jon Shematek, MD June 22, 2005

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CareFirst’sPay for Quality ProgramsJon Shematek, MDJune 22, 2005

  2. Quality-Based Payment • Current program description • Successes • Future Directions • Bridges to Excellence Pilot • Consumer Impact

  3. BlueChoice Primary Care Physician Recognition Program (PCPRP) • Objective: • Assess performance of practices relative to peers • Reward those practices which perform well • Provide incentives for other practices to improve • Current Program: • Implemented January 1998 • For 2004, involves 2,600 BlueChoice PCPs caring for 370,000 members • Administered on a practice level • Must have 50 panel members • Must have a profile score (sufficient claims data needed) • 11 measures • Report Card • Result is PMPM bonus level from $0 - $4.50; strive for average PMPM of $2.25 • Qualifying practices receive 90% of fee schedule • $10.5 million paid out annually

  4. BlueChoice PCP RecognitionProgram Measures Improvements in Preventive services, Chronic care and Member satisfaction— but cannot be directly attributed to this program • Credentials and Experience • Preventive Health Services • Patient Satisfaction Survey Results • Turnover of Panel Members • Convenient Appointment Hours • Number of Members/PCP • Open Panels • E-business Practices • Substantiated Member Complaints • Practice Attendance at a CareFirst Professional Provider Seminar • Efficient Use of Medical Resources

  5. Bridges to Excellence Pilot Program • Launched 1Q 2005 • Voluntary • Third party program (BTE, NCQA) with administrative support from CareFirst • Recognition and rewards structure and process • Health Information Technology (EMR, e-Rx) • Risk assessment, cultural competency • Chronic care management • Pilot practices • 29 locations • 94 primary care physicians • 60,000 CareFirst members, all lines of business, fully and self-insured • Plan to provide $1.3 M in 2005 • Widespread positive response to program launch • Metrics • Participation and successful NCQA certification • Adoption and use of HIT • Improved clinical processes and outcomes • Improved use of Plan services (disease and case management)

  6. Considerations for Next Generation Pay for Quality Program at CareFirst • Simplicity • Attribution rules, significant “n”, comparability • Voluntary • Actionable quality measures based on broad consensus • HEDIS, AQA, NQF • Use of external programs for certification • BTE, NCQA • Reward achievement/improvement • Variable fee schedule vs. “bonus” • Launch 2007 (notification January, 2006)

  7. Impact on Consumers • Currently nil • Large employer request/requirement • Variable by market • Recognition in addition to financial rewards catalyzes practice change and may move consumers to higher quality physicians

More Related