PCMH Performance Measures Incentive Payment Program Summary

1. PCMH Performance Measures Incentive Payment Program Summary Program Goals and Parameters: Performance Measure Incentive program goal is threefold: Provide an additional financial incentive (beyond the Enhanced Fee Schedule Payments) for PCMH program participation Provide practices with actual measure outcomes Use as a ‘baseline’ for the following year’s Improvement Measures Incentive calculation Practices qualify with: NCQA PCMH Level 2 or Level 3 and; Participation as a DSS PCMH approved practice for one full calendar year 3 Practices qualified for the Incentive Payment: a small practice with less than 200 attributed members a medium size practice group with 3 approved sites and almost 2,000 attributed members a very large practice group with 86 approved sites and approximately 20,000 attributed members 2012 Performance Incentive Payment Program: Measurement timeframe was calendar year 2012 Mean performance percentile determined the payment per continuously attributed member for 2012: Under 25th percentile No Payment 25th-50th percentile $0.15 per member month (25% of possible payment) 51st-75th percentile $0.30 pmm (50% of possible payment) 76th-90th percentile $0.45 pmm (75% of possible payment) 91st-100th percentile $0.60 pmm (100% of possible payment)

2. 2012 PCMH Performance Measures Incentive Payment Program Summary • Department of Social Services Person-Centered Medical Home Program Quality Performance Measures effective January 1, 2012: • Pediatric Quality Measures: • Well-child visits in the first 15 months of life (W15) • Well-child visits in the third, fourth, fifth and sixth years of life (W34) • Adolescent well-care visits (AWC) • Percentage of eligible beneficiaries ages 1-21 with at least one dental visit during the measurement year (ADV) • Annual percentage of asthma patients (ages 2-20) with one or more asthma-related emergency department visits (ASM ED) • Use of appropriate medications for people with asthma, with several age ranges 5-11, 12-18 and total 5-18 (ASM) • Rate of emergency department visits per 1,000 member months per month (ages birth-19) (AMB ED) • Developmental screening in the first three years of life. Three age breakouts (ages 1, 2, and 3) (DEV SCRN) • PCMH CAHPS Survey (CAHPS)

3. 2012 PCMH Performance Measures Incentive Payment Program Summary DSS PCMH PROGRAMQUALITY PERFORMANCE MEASURES Adult Quality Measures: Adults ages 18-75 with a diagnosis of Type I or Type II diabetes who received at least one LDL-C screening during the measurement year (CDC-LDL) Adults ages 18-75 with a diagnosis of Type I or Type II diabetes who received at least one eye screening for diabetic retinal disease in a two year period (CDC-EYE) Adults ages 18-75 discharged alive for AMI, coronary artery bypass graft or percutaneous coronary interventions of the year prior to the measurement period or who had a diagnosis of ischemic vascular disease during the measurement period and the year prior to the measurement period who had an LDL-C test during the measurement period. (CMC) Post-Admission Follow-up: Percentage of adults ages 21-75 with inpatient “medicine” admissions with a claim for post-admission follow-up with a physician, PA, or APRN within seven days of the inpatient discharge. (POST ADMIT FUP) Use of appropriate medications for people with asthma, with several age ranges 19-50, 51-64 and total 19-64 (ASM) Percentage of adults given a new psychiatric diagnoses, and medication, by a PCP who received a follow-up visit within 30 days (PSYCH DX/MED FUP) Readmission rate within 30 days after discharge (READMIT) Emergency department usage (AMB ED) PCMH CAHPS Survey (CAHPS)

4. 2012 PCMH Performance Measures Incentive Payment Program Summary Measurement score methodology: 1.Based on claims data analysis (except PCMH CAHPS survey), each measure was given a raw score. 2. Raw scores included the number of times the measure was met divided by the overall count for that category resulting in a numerator and a denominator. For example, the Pediatric Annual Dental Visit measure denominator is any attributed member between 2-21 years of age. 3. The numerator is the number of members in the denominator that had the qualifying “event” of each measure based on the measure's specifications. Using the Dental Visit measure example, a member that had a dental visit that occurred once during the measurement period of Calendar Year 2012 would be included in the numerator. 4. The raw score was converted to a percentile relative to the other PCMH practice raw scores. 5. The "Mean Performance Percentile" is the mean of the percentile scores used to determine the Incentive Payment.

5. PCMH Performance Measures Incentive Payment Program Summary Pediatric Measure Results Only practices that met the measurement’s criteria e.g. minimum number of members were reported

6. PCMH Performance Measures Incentive Payment Program Summary Adult Measure Results Only practices that met the measurement’s criteria e.g. minimum number of members were reported

7. PCMH Performance Measures Incentive Payment Program Summary Overall Results of the Three Practices