Other (specify) Yes/No. Other (specify) Yes/No. 4.2.2.2.3.3 Liver Transplants Liver Transplant Center of Excellence Contracted for Liver Transplants and available to Covered California Enrollees Rady Childrens Hosp & Health Center Yes/No. Childrens Hospital Los Angeles Yes/No. Cedars-Sinai Med Center Yes/No. Scripps Green Hospital Yes/No. UCI Medical Center Yes/No. Loma Linda Univ Med Ctr Yes/No. UCSF Medical Center at Mission Bay Yes/No. Lucile Salter Packard Childrens Hosp Yes/No. California Pacific Med Ctr Yes/No. UCSD Medical Center Yes/No.
Chao Family Comprehensive Cancer Center UC Irvine Yes/No. Stanford Cancer Institute Stanford University Yes/No. City of Hope Comprehensive Cancer Center Yes/No. UC Davis Comprehensive Cancer Center Yes/No. Jonsson Comprehensive Cancer Center UCLA Yes/No. UC San Diego Moores Cancer Center UCSD Yes/No. Salk Institute Cancer Center Yes/No. UCSF Helen Diller Family Comprehensive Cancer Center UCSF Yes/No. Sanford Burnham Prebys Medical Discovery Institute Yes/No. USC Norris Comprehensive Cancer Center Yes/No. Other (specify) Yes/No. Other (specify) Yes/No. 4.3.1.2.3.7 Burns Centers
St. Vincent Medical Center Yes/No. UCLA Medical Center Yes/No. Keck Hospital of USC Yes/No. Other: Yes/No. Other: Yes/No. 4.3.2.2.3.2 Lung Transplants Lung Transplant Center of Excellence Contracted for Lung Transplants and available to Covered California Enrollees Childrens Hospital Los Angeles Yes/No. Cedars-Sinai Med Center Yes/No. Lucile Salter Packard Childrens Hosp Yes/No. UCSD Medical Center Yes/No. Univ of CA San Francisco Med Ctr Yes/No. Sharp Memorial Hospital Yes/No. UC Davis Medical Center Yes/No. Stanford Univ Med Ctr Yes/No.
Salk Institute Cancer Center Yes/No. UCSF Helen Diller Family Comprehensive Cancer Center UCSF Yes/No. Sanford Burnham Prebys Medical Discovery Institute Yes/No. USC Norris Comprehensive Cancer Center Yes/No. Other (specify) Yes/No. Other (specify) Yes/No. 4.3.2.2.3.7 Burns Centers Burn Centers Contracted for Burn Care and available to Covered California Enrollees LAC+USC Medical Center Burn Center Yes/No. UCI Regional Burn Center Yes/No. Shriners Hospital for Children - Northern California Pediatric Burn Center Yes/No. UC Davis Regional Burn Center Adult Burn Center Yes/No. University of California San Diego Yes/No. Saint Francis Memorial Hospital Bothin Burn Center Yes/No.
UCLA Medical Center Yes/No. Keck Hospital of USC Yes/No. Other (specify) Yes/No. Other (specify) Yes/No. 4.4.1.2.3.4 Kidney Transplants Kidney Transplants Centers of Excellence Contracted for Kidney Transplants and available to Covered California Enrollees St Bernardine Med Center Yes/No. Alta Bates Med Ctr Yes/No. Rady Childrens Hosp & Health Center Yes/No. Childrens Hospital Los Angeles Yes/No. Cedars-Sinai Med Center Yes/No. Scripps Green Hospital Yes/No. UCI Medical Center Yes/No. Kaiser Permanente-San Fran. Med. Ctr Yes/No.
Other (specify) Yes/No. 4.4.1.2.3.6 Comprehensive Cancer Care Centers Comprehensive Cancer Care Centers Contracted for Comprehensive Cancer Care Centers and available to Covered California Enrollees Chao Family Comprehensive Cancer Center UC Irvine Yes/No. Stanford Cancer Institute Stanford University Yes/No. City of Hope Comprehensive Cancer Center Yes/No. UC Davis Comprehensive Cancer Center Yes/No. Jonsson Comprehensive Cancer Center UCLA Yes/No. UC San Diego Moores Cancer Center UCSD Yes/No. Salk Institute Cancer Center Yes/No. UCSF Helen Diller Family Comprehensive Cancer Center UCSF Yes/No. Sanford Burnham Prebys Medical Discovery Institute Yes/No. USC Norris Comprehensive Cancer Center Yes/No. Other (specify) Yes/No.
Jonsson Comprehensive Cancer Center UCLA Yes/No. UC San Diego Moores Cancer Center UCSD Yes/No. Salk Institute Cancer Center Yes/No. UCSF Helen Diller Family Comprehensive Cancer Center UCSF Yes/No. Sanford Burnham Prebys Medical Discovery Institute Yes/No. USC Norris Comprehensive Cancer Center Yes/No. Other (specify) Yes/No. Other (specify) Yes/No. 4.4.2.2.3.7 Burns Centers Burn Centers Contracted for Burn Care and available to Covered California Enrollees LAC+USC Medical Center Burn Center Yes/No. UCI Regional Burn Center Yes/No. Shriners Hospital for Children - Northern California Pediatric Burn Center Yes/No. UC Davis Regional Burn Center Adult Burn Center Yes/No.
4.5.1.2.1.1 Does contractor currently use Patient safety as a criterion for provider selection for covered California networks? If yes, please explain in detail: this should include the assessment process, the source of the patient safety assessment data, specific measures and metrics, thresholds for inclusion and exclusion. Single, Radio group. 1: Yes, please explain [ 1000 words ] , 2: No 4.5.1.2.1.2 Does contractor currently use cost efficiency as a criterion for provider selection for covered California networks? If yes, please explain in detail: this should include the assessment process, the source of the assessment data, specific measures and metrics, thresholds for inclusion and exclusion. Single, Radio group. 1: Yes, please explain [ 1000 words ] , 2: No 4.5.1.2.1.3 Does contractor currently use Patient reported experience as a criterion for provider selection for covered California networks? If yes, please explain in detail: this should include the assessment process, the source of the Patient reported experience assessment data, specific measures and metrics, thresholds for inclusion and exclusion. Single, Radio group. 1: Yes, please explain [ 1000 words ] , 2: No 4.5.1.2.2 Volume - Outcome Relationship Numerous studies have demonstrated a significant correlation between volume of procedures performed by providers and facilities and better outcomes for those procedures. This applies to both common but high risk treatments such as cancer surgeries and cardiac procedures as well as complicated, rare and highly specialized procedures such as transplants. Higher volumes, documented experience and proficiency with all aspects of care underlie successful outcomes, including patient selection, anesthesia and postoperative care. 4.5.1.2.2.1 Is procedure volume per facility for the above mentioned conditions tracked by the issuer? Single, Radio group. 1: Yes, 2: No 4.5.1.2.2.2 If yes please provide the following details: Data Sources Methodology for categorizing facilities according to volume-outcome relationship Volume thresholds (i.e. at what volume per procedure is a facility considered proficient) 2000 words. 4.5.1.2.2.3 Does issuer apply this information to enrollee procedure referral (including Covered California enrollees)? Single, Radio group. 1: Yes, 2: No 4.5.1.2.2.4 If yes please provide the following details:
Ending Date of Service Single, Pull-down list. 1: Yes, 2: No 50 words. 6.8.5 Can Applicant supply all applicable Provider Tax ID Numbers (TINs), National Provider Identifiers (NPIs), and National Council for Prescription Drug Programs (NCPDP) Numbers (pharmacy only) for individual providers? If not, or if yes with deviation, explain. Provider IDs to be Supplied Response Yes, unless values represent individual provider Social Security numbers If No or Yes with deviation, explain. TIN Single, list. 1: Yes, 2: No Unlimited. 50 words. NPI Single, list. 1: Yes, 2: No Unlimited. 50 words. NCPDP Number Single, list. 1: Yes, 2: No Unlimited. 50 words. 6.8.6 Can Applicant provide detailed coding for diagnosis, procedures, etc. on all claims for all data sources? If not, or if yes with deviation, explain. Coding to be Provided Response If No or Yes with deviation, explain. Diagnosis Coding Single, Pull-down list. 1: Yes, 2: No 50 words. Procedure Coding (CPT, HCPCS) Single, Pull-down list. 1: Yes, 2: No 50 words. Revenue Codes (Facility Only) Single, Pull-down list. 1: Yes, 2: No 50 words. Place of Service Single, Pull-down list. 1: Yes, 2: No 50 words. NDC Code (Drug Only) Single, Pull-down list. 1: Yes, 2: No 50 words.
NCQA Disease Management – Certification Multi, Checkboxes. 1: Program Design, 2: Systems, 3: Contact, 4: NCQA not used To the day. From December 30, 1973 to December 31, 2023. Unlimited. NCQA Case Management Accreditation Single, Radio group. 1: Accredited - 3 years, 2: Accredited - 2 years, 3: No accreditation To the day. From December 30, 1973 to December 31, 2023. Unlimited. NCQA PHQ Certification Single, Pull-down list. 1: Certified, 2: No PHQ Certification To the day. From December 30, 1973 to December 31, 2023. Unlimited. NCQA Multicultural Health Care Distinction Single, Radio group. 1: Distinction, 2: No MHC Distinction To the day. From December 30, 1973 to December 31, 2023. URAC Accreditations Multi, Checkboxes - optional. 1: URAC not used URAC Accreditations - Health Plan Single, Radio group. 1: URAC Accredited, 2: Not URAC Accredited To the day. From December 30, 1973 to December 31, 2023. URAC Accreditation - Comprehensive Wellness Single, Radio group. 1: URAC Accredited, 2: Not URAC Accredited To the day. From December 30, 1973 to December 31, 2023. URAC Accreditations - Disease Management Single, Radio group. 1: URAC Accredited, 2: Not URAC Accredited To the day. From December 30, 1973 to December 31, 2023. URAC Accreditations - Health Utilization Management Single, Radio group. 1: URAC Accredited, 2: Not URAC Accredited To the day. From December 30, 1973 to December 31, 2023. URAC Accreditations - Case Management Single, Radio group. 1: URAC Accredited, 2: Not URAC Accredited To the day. From December 30, 1973 to December 31, 2023. URAC Accreditations - Pharmacy Benefit Management Single, Radio group. 1: URAC Accredited, 2: Not URAC Accredited To the day. From December 30, 1973 to December 31, 2023. 9.3.1.2 If the Health Plan indicated any accreditations above, provide a copy of the accrediting agency's certificate and upload as a file title “Accreditation 1a.” Single, Pull-down list. 1: 1: Yes, Health Status 1a attached, 2: Not attached
2: Not Engaged NCDR® (National Cardiovascular Data Registry that currently includes seven specific registry programs) 50 words. Single, Radio group. 1: Engaged, 2: Not Engaged 50 words. Society of Thoracic Surgeons National Database for the collection of general thoracic surgery clinical data 50 words. Single, Radio group. 1: Engaged, 2: Not Engaged 50 words. National Neurosurgery Quality and Outcomes Database (N2QOD)ety of Thoracic Surgeons National Database for the collection of general thoracic surgery clinical data 50 words. Single, Radio group. 1: Engaged, 2: Not Engaged 50 words. IHA Payment Bundling demonstration 50 words. Single, Radio group. 1: Engaged, 2: Not Engaged 50 words. Centers for Medicare and Medicaid Innovation (CMMI) Bundled Payments for Care Improvement initiative (BPCI) 50 words. Single, Radio group. 1: Engaged, 2: Not Engaged 50 words. CMMI Comprehensive Primary Care initiative (CPC) 50 words. Single, Radio group. 1: Engaged, 2: Not Engaged 50 words. CMMI Transforming Clinical Practice Initiative 50 words. Single, Radio group. 1: Engaged, 2: Not Engaged 50 words. CMMI Shared Savings Program (including Pioneer, Advanced Payment and other models) 50 words. Single, Radio group. 1: Engaged, 50 words.
From 0 to 100. From 0 to 100. LEAPFROG Safety Practices Leapfrog Safety Score Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. Adoption of CPOE Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. Management of Patients in ICU Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. Evidence-Based Hospital referral indicators Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. Adoption of NQF endorsed Safe Practices Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. Maternity – pre 39 week elective induction and/or elective c-section rates Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. HOSPITAL QUALITY INSTITUTE HOSPITAL ENGAGEMENT NETWORK CAUTI Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. CLABSI Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. Surgical site infections (SSI) Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100.
Adverse drug events (ADE) Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. C. difficile colitis Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. Sepsis mortality Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. OTHER MEASURES HACs – healthcare acquired conditions also known as hospital acquired conditions (e.g., Surgical site infection following coronary artery bypass graft (CABG)—mediastinitis) Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. SREs (serious reportable events) that are not HACs (e.g., surgery on the wrong body part or wrong patient) www.qualityforum.org/Topics/SREs/List_of_SREs.aspx (see attachment) Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. Readmissions Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. ED/ER Visits Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. MORTALITY MEASURES (AMI, HF and Pneumonia mortality measures) Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. ICU Mortality Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. HIT adoption/use Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100.
9.4.5 Health and Wellness Services 9.4.5.1 Identify Health plan activities in calendar year 2015 for practitioner education and support related to obesity management for networks serving Covered California members. Check all that apply. If any of the following four (4) activities are selected, documentation must be provided as Health-Wellness 1 in the following question: 1: Member-specific reports or reminders to treat (1a) 2: Periodic member program reports (1b) 3: Comparative performance reports (1c) 4: General communication to providers announcing resources/programs available for weight management services (1d) Activities Education/Information Multi, Checkboxes. 1: General education of guidelines and Health plan program offerings, 2: Educate providers about screening for obesity in children, 3: Notification of member identification, 4: CME credit for obesity management education, 5: Comparative performance reports (identification, referral, quit rates, etc.), 6: Promotes use of Obesity ICD-9 coding (e.g. 278.0) and ICD-10 (E66.9, E66.01, E66.3 and E66.2) (describe how codes are promoted), 7: Distribution of BMI calculator to physicians, 8: 8: Reminder to HCPs to “turn on” BMI alert in EMR that calculates automatically, 9: None of the above Patient Support Multi, Checkboxes. 1: Supply of materials/education/information therapy for provision to members, 2: Member-specific reports or reminders to screen, 3: Member-specific reports or reminders to treat (obesity status already known), 4: Periodic reports on members enrolled in support programs, 5: None of the above Incentives Multi, Checkboxes. 1: Incentives to conduct screening (describe), 2: Incentive to refer to program or treat (describe), 3: Health plan reimburses for appropriate use of Obesity ICD-9 coding (e.g. 278.0) and ICD-10 (E66.9, E66.01, E66.3 and E66.2), 4: Incentives to obtain NCQA Physician Recognition – (e.g. Physician Practice Connections or Patient Centered Medical Home), 5: None of the above Practice Support Multi, Checkboxes. 1: The Health plan provides care managers and/or
completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered independently of medical services and contingent upon completion/participation, 4: Not supported Participation in weight-loss program (exercise and/or diet/nutrition) Multi, Checkboxes. 1: Waive/adjust out-of-pocket payments for tests, treatments, Rx contingent upon completion/participation, 2: Part of program with reduced Premium Share contingent upon completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered independently of medical services and contingent upon completion/participation, 4: Not supported Percent. N/A OK. From 0 to 100. Yes/No. Success in weight-loss or maintenance Multi, Checkboxes. 1: Waive/adjust out-of-pocket payments for tests, treatments, Rx contingent upon completion/participation, 2: Part of program with reduced Premium Share contingent upon completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered independently of medical services and contingent upon completion/participation, 4: Not supported Percent. N/A OK. From 0 to 100. Yes/No. Participation in tobacco cessation Multi, Checkboxes. 1: Waive/adjust out-of-pocket payments for tests, treatments, Rx contingent upon completion/participation, 2: Part of program with reduced Premium Share contingent upon completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered independently of medical services and contingent upon completion/participation, 4: Not supported Percent. N/A OK. From 0 to 100. Yes/No. Success with tobacco cessation goals Multi, Checkboxes. 1: Waive/adjust out-of-pocket payments for tests, treatments, Rx contingent upon completion/participation, 2: Part of program with reduced Premium Share contingent upon completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered Percent. N/A OK. From 0 to 100. Yes/No.
9.4.7.3 Does the Health plan currently have benefit designs in place that reduce barriers or provide incentives for preventive or wellness services by any of the means listed in the "Financial incentives" column? In the “Uptake” column, estimate the percentage of California members participating in Health plan designs with the barrier reduction or incentive features for the row topic (e.g. diabetes). Numerator should be the number of California members actually enrolled in such a Health plan design/Denominator is total Health plan enrollment. This question does NOT have a regional flag- for uptake percentage, please provide the statewide percentage using numbers in numerator and denominator that reflect the plan's entire membership across all markets. For a regional Health plan operating in only the market of response, their response would be considered statewide in this context. Please respond accordingly in the last column. PPO response - Preventive and Wellness Services Financial Incentives Uptake as % of total California statewide membership noted in Section 3 Percentage is based on Health plan's California membership in all markets of Health plan operation Incentives contingent upon member behavior Participation in Medical Home Practices Multi, Checkboxes. 1: Waive/adjust out-of-pocket payments for tests, treatments, Rx contingent upon completion/participation, 2: Part of program with reduced Premium Share contingent upon completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered independently of medical services and contingent upon completion/participation, 4: Waived or decreased for reaching prevention goals, 5: Incentives to adhere to evidence-based self-management guidelines, 6: Incentives to adhere to recommended care coordination encounters, 7: Not supported Percent. N/A OK. From 0 to 100. Yes/No. Participation in other Plan-designated high performance practices Multi, Checkboxes. 1: Waive/adjust out-of-pocket payments for tests, treatments, Rx contingent upon completion/participation, 2: Part of program with reduced Premium Share contingent upon completion/participation, 3: Rewards (cash payments, discounts for consumer goods, etc.) administered Percent. N/A OK. From 0 to 100. Yes/No.
Number of unique members with a web/telehealth consultation in the applicable calendar year per thousand members Decimal. N/A OK. From 0 to 1000000000. Multi, Checkboxes. N/A OK. 1: Web, 2: Telehealth via web, 3: Telehealth via phone, 4: Combination of Web and Telehealth Single, Radio group. N/A OK. 1: Regional, 2: National 12 If the plan had Covered California business in 2015: Number of unique Covered California members with a web/telehealth consultation in the applicable calendar year per thousand members Decimal. N/A OK. From 0 to 1000000000. Multi, Checkboxes. N/A OK. 1: Web, 2: Telehealth via web, 3: Telehealth via phone, 4: Combination of Web and Telehealth Single, Radio group. N/A OK. 1: Regional, 2: National 13 Health plan provides a structured template for web/telehealth consultations (versus free flow email) Multi, Checkboxes. 1: Yes structured template, 2: Yes structured secure platform, 3: No Multi, Checkboxes. N/A OK. 1: Web, 2: Telehealth via web, 3: Telehealth via phone, 4: Combination of Web and Telehealth Single, Radio group. N/A OK. 1: Regional, 2: National 14 Health plan reimburses for web/telehealth consultations Single, Radio group. 1: Yes, 2: No Multi, Checkboxes. N/A OK. 1: Web, 2: Telehealth via web, 3: Telehealth via phone, 4: Combination of Web and Telehealth Single, Radio group. N/A OK. 1: Regional, 2: National 15 Plan's web/telehealth consultation services are available to all of members/employers Single, Radio group. 1: Yes - with no additional fee, 2: Yes - additional fee may be assessed, depending on contract, 3: Yes - always for an Multi, Checkboxes. N/A OK. 1: Web, 2: Telehealth via web, 3: Telehealth via phone, Single, Radio group. N/A OK. 1: Regional, 2: National 16
the member. Examples include devices that monitor weight, lab levels, etc. as well as activities that are customized and tailored based on the member's health status/risk factors. Interactive implies a response mechanism that results in calibration of subsequent interventions. This category does not include searchable static web information. (Documentation needed) Number provided, 6: Offered but not tracked regionally or statewide Self-initiated text/email messaging Multi, 1: HMO, 2: PPO, 3: Intervention not offered, 4: Regional Number provided, 5: National Number provided, 6: Offered but not tracked regionally or statewide Decimal. From 0 to Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown Interactive IVR with information capture Multi, 1: HMO, Decimal. From 0 to Multi, 1: Low, Unknown Unknown
Answer “Interactive IVR with information capture” only if it involves record updates and/or triggering additional intervention. 2: PPO, 3: Intervention not offered, 4: Regional Number provided, 5: National Number provided, 6: Offered but not tracked regionally or statewide 2: Medium, 3: High risk, 4: No stratification IVR with outbound messaging only Multi, 1: HMO, 2: PPO, 3: Intervention not offered, 4: Regional Number provided, 5: National Number provided, 6: Offered but not tracked regionally or statewide Decimal. From 0 to Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown Live outbound telephonic coaching program (count only members that are successfully engaged) Multi, 1: HMO, 2: PPO, 3: Intervention not offered Decimal. From 0 to Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown 9.4.9.2 Review the two most recently uploaded years of HEDIS results for the Plan HMO product based on QC 2015 and QC 2014. If a plan did not report a certain measure to Quality Compass (QC), or NCQA chose to exclude a certain value, instead of a rate, QC may have codes such as NR (not reported), EXC (Excluded), etc. To reflect this result in a numeric form for uploading, the following coding was devised: -1 means 'NR' -2 means 'NA'
diabetes DM program General member education (e.g., newsletters) Multi, 1: HMO, 2: PPO, 3: Intervention not offered Decimal. From 0 to 100000000000. Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown General care based on condition alone (e.g., personalized letter) Multi, 1: HMO, 2: PPO, 3: Intervention not offered Decimal. From 0 to 100000000000. Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown Member-specific reminders for due or overdue clinical/diagnostic maintenance services Answer reminders” only if it involves reminders that are independent of the live outbound telephonic program (Documentation needed) Multi, 1: HMO, 2: PPO, 3: Intervention not offered Decimal. From 0 to 100000000000. Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown Member-specific reminders for medication events (e.g., level of use, failure to refill) Answer reminders” only if it involves reminders that are independent of the live outbound telephonic Multi, 1: HMO, 2: PPO, 3: Intervention not offered Decimal. From 0 to 100000000000. Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown
program (Documentation needed) Online interactive self-management support. "Online self-management support" is an intervention that includes two-way electronic communication between the Health plan and the member. Examples include devices that monitor weight, lab levels, etc. as well as activities that are customized and tailored based on the member's health status/risk factors. Interactive implies a response mechanism that results in calibration of subsequent interventions. This category does not include searchable static web information. (Documentation needed) Multi, 1: HMO, 2: PPO, 3: Intervention not offered, 4: Regional Number provided, 5: National Number provided, 6: Offered but not tracked regionally or statewide Decimal. From 0 to Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown Self-initiated text/email messaging Multi, 1: HMO, 2: PPO, 3: Intervention not offered, 4: Regional Decimal. From 0 to Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown
Number provided, 5: National Number provided, 6: Offered but not tracked regionally or statewide Interactive IVR with information capture Answer “Interactive IVR with information capture” only if it involves information capture of member response information for record updates and/or triggering additional intervention. Multi, 1: HMO, 2: PPO, 3: Intervention not offered, 4: Regional Number provided, 5: National Number provided, 6: Offered but not tracked regionally or statewide Decimal. From 0 to Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown IVR with outbound messaging only Multi, 1: HMO, 2: PPO, 3: Intervention not offered, 4: Regional Number provided, 5: National Number provided, 6: Offered but not tracked regionally or statewide Decimal. From 0 to Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown Live outbound telephonic coaching program (count only members that are successfully engaged) Multi, 1: HMO, 2: PPO, 3: Intervention not offered Decimal. From 0 to 100000000000. Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown
Starting at Row 4, based on the Health plan’s stratification of members with Asthma, indicate the types of interventions that are received by the population based on the level of risk segmentation. Enter “Zero” if the intervention is not provided to members with Asthma. Select “Interactive IVR with information capture” only if it involves record updates and/or triggering additional intervention. Select “member-specific reminders” only if it involves reminders that are independent of the live outbound telephonic program. Select online interactive self-management only if the application involves customized information based on branch logic. Interactive implies a response mechanism that results in calibration of subsequent interventions. This category does not include static web information. A member is “actively engaged” in the outbound telephonic program if they participate beyond the initial coaching call. For member counts use the number of members as of December 31who participated in the activity at any time during the applicable calendar year. Number of as in rows 1, 2 and 3 Indicate if Offered to Asthma Patients in this Number of California members 5 years and above in this state/market receiving intervention (if Health plan offers intervention but does not track participation, enter zero) Risk strata that receives this % of HEDIS Asthma eligibles who received intervention % of Health plan Asthma eligibles who received intervention Number of members aged 5 and above in this market Using the NCQA “Eligible Population” definition for Asthma on page 123 of the 2015 HEDIS Technical Specifications Vol 2., provide number of members 5 and above with Asthma Using the plan's own criteria, provide number of members
identified with condition and eligible to participate in asthma DM program General member education (e.g., newsletters) Multi, 1: HMO, 2: PPO, 3: Intervention not offered Decimal. From 0 to 100000000000. Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown General care based on condition alone (e.g., personalized letter) Multi, 1: HMO, 2: PPO, 3: Intervention not offered Decimal. From 0 to 100000000000. Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown Member-specific reminders for due or overdue clinical/diagnostic maintenance services Answer reminders” only if it involves reminders that are independent of the live outbound telephonic program (Documentation needed) Multi, 1: HMO, 2: PPO, 3: Intervention not offered Decimal. From 0 to 100000000000. Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown Member-specific reminders for medication events (e.g., level of use, failure to refill) Answer reminders” only if it involves Multi, 1: HMO, 2: PPO, 3: Intervention not offered Decimal. From 0 to 100000000000. Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown
reminders that are independent of the live outbound telephonic program (Documentation needed) Online interactive self-management support. "Online self-management support" is an intervention that includes two-way electronic communication between the Health plan and the member. Examples include devices that monitor weight, lab levels, etc. as well as activities that are customized and tailored based on the member's health status/risk factors. Interactive implies a response mechanism that results in calibration of subsequent interventions. This category does not include searchable static web information. (Documentation needed) Multi, 1: HMO, 2: PPO, 3: Intervention not offered, 4: Regional Number provided, 5: National Number provided, 6: Offered but not tracked regionally or statewide Decimal. From 0 to Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown Self-initiated text/email messaging Multi, 1: HMO, Decimal. From 0 to Multi, 1: Low, Unknown Unknown
2: PPO, 3: Intervention not offered, 4: Regional Number provided, 5: National Number provided, 6: Offered but not tracked regionally or statewide 2: Medium, 3: High risk, 4: No stratification Interactive IVR with information capture Answer “Interactive IVR with information capture” only if it involves information capture of member response information for record updates and/or triggering additional intervention. Multi, 1: HMO, 2: PPO, 3: Intervention not offered, 4: Regional Number provided, 5: National Number provided, 6: Offered but not tracked regionally or statewide Decimal. From 0 to Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown IVR with outbound messaging only Multi, 1: HMO, 2: PPO, 3: Intervention not offered, 4: Regional Number provided, 5: National Number provided, 6: Offered but not tracked regionally or statewide Decimal. From 0 to Multi, 1: Low, 2: Medium, 3: High risk, 4: No stratification Unknown Unknown Live outbound telephonic coaching program Multi, 1: HMO, Decimal. From 0 to 100000000000. Multi, 1: Low, Unknown Unknown
(count only members that are successfully engaged) 2: PPO, 3: Intervention not offered 2: Medium, 3: High risk, 4: No stratification 9.4.9.10 Review HEDIS scores for the indicators listed. If a plan did not report a certain measure to Quality Compass (QC), or NCQA chose to exclude a certain value, instead of a rate, QC may have codes such as NR (not reported), EXC (Excluded), etc. To reflect this result in a numeric form for uploading, the following coding was devised: -1 means 'NR' -2 means 'NA' -3 means 'ND' -4 means 'EXC' and -5 means 'NB' Please refer to the attached document for an explanation of terms This answer is supplied by Health Benefit Exchange (individually). All Not Provided HEDIS QC 2015 (HMO) HEDIS QC 2014 (HMO) Use of Appropriate Medications for People with Asthma - Total Percent. From -10 to 100. All Not Provided Percent. From -10 to 100. All Not Provided 9.4.9.11 Review HEDIS scores for the indicators listed. If a plan did not report a certain measure to Quality Compass (QC), or NCQA chose to exclude a certain value, instead of a rate, QC may have codes such as NR (not reported), EXC (Excluded), etc. To reflect this result in a numeric form for uploading, the following coding was devised: -1 means 'NR' -2 means 'NA' -3 means 'ND' -4 means 'EXC' and -5 means 'NB' Please refer to the attached document for an explanation of terms This answer is supplied by Health Benefit Exchange (individually). All Not Provided PPO HEDIS QC 2015 (PPO) HEDIS QC 2014 (PPO)
of a specific program as a buy-up option for fully insured lives, 7: Intervention available outside of a specific program as option for self-insured lives, 8: Not available Online interactive self-management support. "Online self-management support" is an intervention that includes two-way electronic communication between the Plan and the member. Examples include devices that monitor weight, lab levels, etc. as well as web-support activities that are customized and tailored based on the member's health status/risk factors. Interactive implies a response mechanism that results in calibration of subsequent interventions. This category does not include searchable static web information. Multi, Checkboxes. 1: HMO, 2: PPO, 3: Intervention not offered, 4: Regional Number provided, 5: National Number provided, 6: Offered but not tracked Decimal. From 0 to 100000000000000. Multi, Checkboxes. 1: Included as part of high-risk program with no additional fee, 2: Inclusion of this intervention requires an additional fee, 3: Inclusion of this intervention sometimes requires additional fee, depending on contract , 4: Intervention available outside of a specific program as a standard benefit for fully insured lives, 5: Intervention available outside of a specific program as a standard benefit for self-insured lives (part of the ASO fee), 6: Intervention available outside of a specific program as a buy-up option for fully insured lives, 7: Intervention available outside of a specific program as option for Unknown up up
self-insured lives, 8: Not available Self-initiated text/email messaging Multi, Checkboxes. 1: HMO, 2: PPO, 3: Intervention not offered, 4: Regional Number provided, 5: National Number provided, 6: Offered but not tracked Decimal. From 0 to 100000000000000. Multi, Checkboxes. 1: Included as part of high-risk program with no additional fee, 2: Inclusion of this intervention requires an additional fee, 3: Inclusion of this intervention sometimes requires additional fee, depending on contract , 4: Intervention available outside of a specific program as a standard benefit for fully insured lives, 5: Intervention available outside of a specific program as a standard benefit for self-insured lives (part of the ASO fee), 6: Intervention available outside of a specific program as a buy-up option for fully insured lives, 7: Intervention available outside of a specific program as option for self-insured lives, 8: Not available Unknown Interactive IVR with information capture Answer “Interactive IVR with information Multi, Checkboxes. 1: HMO, 2: PPO, 3: Intervention not offered, Decimal. From 0 to 100000000000000. Multi, Checkboxes. 1: Included as part of high-risk program with no additional fee, Unknown up
capture” only if it involves information capture of member response information for record updates and/or triggering additional intervention. 4: Regional Number provided, 5: National Number provided, 6: Offered but not tracked 2: Inclusion of this intervention requires an additional fee, 3: Inclusion of this intervention sometimes requires additional fee, depending on contract , 4: Intervention available outside of a specific program as a standard benefit for fully insured lives, 5: Intervention available outside of a specific program as a standard benefit for self-insured lives (part of the ASO fee), 6: Intervention available outside of a specific program as a buy-up option for fully insured lives, 7: Intervention available outside of a specific program as option for self-insured lives, 8: Not available IVR with outbound messaging only Multi, Checkboxes. 1: HMO, 2: PPO, 3: Intervention not offered, 4: Regional Number provided, 5: National Number provided, 6: Offered but not tracked Decimal. From 0 to 100000000000000. Multi, Checkboxes. 1: Included as part of high-risk program with no additional fee, 2: Inclusion of this intervention requires an additional fee, 3: Inclusion of this intervention sometimes requires additional fee, depending on Unknown
7: Compliance (medication refills) is not systematically assessed participants are monitored reminder (e.g. email), 4: Member receives telephone contact, 5: Practitioner is mailed an alert, 6: Practitioner is contacted electronically, 7: Practitioner is contacted by telephone, 8: Telephonic coach is notified, 9: Gap in fills are communicated electronically to personal health record which will trigger a member alert, 10: Other (describe) Diabetes Multi, Checkboxes. 1: Statins, 2: Insulin, 3: 4: Biguanides, 5: DPP-IV inhibitors, 6: Meglitinides, 7: Thiazolidine diones, 8: Sulfonylureas, 9: Other (describe), 10: Compliance (medication refills) is not systematically assessed Multi, Checkboxes. 1: Health plan personnel, 2: PBM, 3: Retail or mail pharmacy, 4: Other (describe) Single, Radio group. 1: All members taking the checked drugs are monitored, 2: Only DM participants are monitored Multi, Checkboxes. 1: Member must activate reminders, 2: Member receives mailed reminders, 3: Member receives electronic reminder (e.g. email), 4: Member receives telephone contact, 5: Practitioner is mailed an alert, 6: Practitioner is contacted electronically, 7: Practitioner is contacted by telephone, 8: Telephonic coach is notified, 9: Gap in fills are communicated electronically to personal health record which will trigger a member alert, 100 words. 100 words.
3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Coronary Artery Disease Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 6 Heart Failure Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 7 Oncology Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 8
Asthma Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 9 NCQA Recognition program certification (consistent with plan response in directory section) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 10 Patient experience survey data (e.g., A-CAHPS) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 11 Mortality or complication rates where applicable Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 12
7: None of the above Efficiency (resource use not unit cost) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 13 Pharmacy management (e.g. generic use rate, formulary compliance) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 14 Medication Safety Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 15 Health IT adoption/use Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 16
5: ACO, 6: Other (describe), 7: None of the above Heart Failure Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 7 Oncology Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 8 Asthma Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 9 NCQA Recognition program certification (consistent with plan response in directory section) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 10
model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Patient experience survey data (e.g., A-CAHPS) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 11 Mortality or complication rates where applicable Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 12 Efficiency (resource use not unit cost) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 13 Pharmacy management (e.g. generic use rate, Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 14
formulary compliance) 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Medication Safety Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 15 Health IT adoption/use Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 16 Preventable Readmissions Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 17
reporting. (EPO) relevant specialists) (EPO) Diabetes Mellitus Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 1 Preventive Care (Osteoporosis screening, urinary incontinence, flu shot, pneumonia vaccination, screening mammography, colorectal cancer screening, BMI screening and follow-up, screening unhealthy alcohol use, tobacco screening use and cessation intervention) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 2 Coronary Artery Bypass Graft Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 3
7: None of the above Oncology Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 8 Asthma Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 9 NCQA Recognition program certification (consistent with plan response in directory section) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 10 Patient experience survey data (e.g., A-CAHPS) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 11
6: Other (describe), 7: None of the above Mortality or complication rates where applicable Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 12 Efficiency (resource use not unit cost) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 13 Pharmacy management (e.g. generic use rate, formulary compliance) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 14 Medication Safety Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 15
4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Health IT adoption/use Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 16 Preventable Readmissions Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 17 Preventable ED/ER Visits (NYU) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Percent. N/A OK. From 0 to 100. Percent. N/A OK. From 0 to 100. 18 9.4.10.10 Indicate the information available through the Plan's on-line physician directory. These data categories are based on the recommendations of the Commonwealth Fund/NCQA consensus panel on electronic physician directories. Use the detail box to describe any updates (e.g., office hours, languages spoken) that a provider is permitted to make directly through an online provider portal or similar tool.
home practices (e.g., intensive self management support to patients, action Contractor development, arrangement for social support follow-up with a social worker or other community support personnel), 11: Patient experience, 12: Health IT adoption or use, 13: Financial results, 14: Utilization results, 15: Pharmacy management, 16: Other - (provide details in next column), 17: Most Dominant measure used - (note in detail box in cell) Does the program have an attribution model for assigning patients to providers? If yes, please describe in second column Multi, Checkboxes. 1: No, 2: Yes 200 words. 19 Indicate the type(s) of benefit and/or provider network features that create member incentives or disincentives to support the payment reform program. Multi, Checkboxes. 1: Mandatory use of Centers of Excellence (COE) or higher performing providers, 2: Financial incentives (lower premium, waived/lower co-pays) for members to use COE/higher performance providers, 3: Financial disincentives for members to use non-COE or lower performing providers (e.g., higher etc.), 4: Use of tiered networks, 5: Use of narrow networks, 6: Reference pricing, 7: High deductible health plans, 8: Value-based insurance design, 9: Incentives to select lower cost sites of care (e.g. worksite clinic, retail clinic, telehealth, ambulatory surgery centers), 10: Preauthorization (e.g. "gatekeeper"), 11: Precertification (e.g. health plan approval), 12: Continued stay review, 13: Step therapy, 14: Objective information (e.g., performance measure results) provided on COEs to members, providing evidence of higher-quality care rendered by these providers, 15: Other (please describe) 65 words. 20 For this payment reform program, do you make information Multi, Checkboxes. 1: We report to the general public, 50 words. 21
If the program pay providers prospectively, please describe the trigger event. 100 words. N/A OK. If the program reconciles the bundled payment retrospectively, please describe how the program pays providers during the course of care (e.g. FFS, capitation) and the reconciliation process. 100 words. N/A OK. 9.4.12.2.9 Indicate the physician/outpatient measures in use for this program. Select all that apply (Note: an expansive list has been provided to facilitate accuracy of reporting, Catalyst for Payment Reform-recommend measures are indicated with*). If using a Composite measure, select composite row and not the individual, underlying measures (e.g., optimal diabetes care) PQRS Measure & Other Measures Level of detail for comparative reporting of physicians who meet the threshold of reliability for reporting. (HMO) Indicate if reporting covers primary care and/or specialty physicians (HMO) Description of Other (if plan selected response option 6) Indicate how measure is used % Physicians receiving award Optimal Diabetes Care Composite* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: HbA1c Poor Control (>9.0%) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance Percent.
6: Other (describe), 7: None of the above determines amount of bonus) CDC: Eye Exam Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Hemoglobin A1c (HbA1c) testing Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Foot Exam Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Medical Attention for Nephropathy Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Percent.
Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) CDC: Blood Pressure Control (<140/80 mm Hg) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Statin Therapy for Patients With Diabetes Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Optimal Cardiovascular Care - Composite Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent.
Controlling High Blood Pressure* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Persistent Beta Blocker Treatment After a Heart Attack Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Statin Therapy for Patients With Cardiovascular Disease* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P Percent.
5: ACO, 6: Other (describe), 7: None of the above or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Cervical Cancer Screening Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Breast Cancer Screening* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Colorectal Cancer Screening* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Endoscopy/Polyp Surveillance: Colonoscopy Interval Multi, Checkboxes. 1: Individual Multi, Checkboxes. 50 words. Multi, Checkboxes. 1: Physician Percent.
for Patients with a History of Adenomatous of Inappropriate Use* Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 1: Primary care, 2: Specialty Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Preventive Care Screening: Tobacco Use: Screening and Cessation Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Screening Unhealthy Alcohol Use Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines Percent. Avoidance
amount of bonus) Tobacco Screening Use and Cessation Intervention Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Other Preventive Care measures Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Use of Imaging Studies for Low Back Pain* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Functional Status Change for Patients with Lumbar Impairments Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, Percent.
model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) CG CAHPS (or Patient Assessment Survey) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Depression Remission at 12 Months Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Depression Remission at 6 Months* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent.
Antidepressant Medication Management* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Screening for Clinical Depression and Plan* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Medication Management for People with Asthma Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. of Antibiotic Treatment in Adults with Acute Bronchitis Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P Percent.
5: ACO, 6: Other (describe), 7: None of the above or Shared Risk, 4: P4P Payment (performance determines amount of bonus) C-section rate* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Early elective deliveries or early inductions without medical indication* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Prenatal and Postpartum Care Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Appropriate Treatment for Children with Multi, Checkboxes. 1: Individual Multi, Checkboxes. 50 words. Multi, Checkboxes. 1: Physician Percent.
Upper Respiratory Infection* Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 1: Primary care, 2: Specialty Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) NCQA Recognition program certification (consistent with plan response in directory section) (E) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Mortality or complication rates where applicable Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Efficiency (resource use not unit cost) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines Percent.
model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Preventable ED/ER Visits (NYU) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Other Measures 500 words. Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) 9.4.12.2.10 Does the program use quality measurement to check for any unidentified negative consequences (underutilization/overutilization) that could result from incentives inherent in the program's payment method? Response Measurement of potential underutilization or overutilization Single, Pull-down list. 1: Yes, 2: No Preventive services Multi, Checkboxes. 1: Monitored for underuse, 2: Monitored for overuse, 3: Not monitored
program? Check all that apply. Note most dominant in next column quality, 2: FFS-based Shared-savings with quality, 3: Non-FFS-based Shared-savings with quality, 4: FFS plus pay for performance, 5: Full capitation with quality, 6: Partial or condition-specific capitation with quality, 7: Bundled payment with quality, 8: FFS-based non-visit functions, 9: Non-FFS-based non-visit functions, 10: Non-payment for specific services that were preventable or services that were unnecessary (detail in row below), 11: Other non-FFS based payment reform models (provide details in box below) previous column, note dominant model in detail box in cell If you have a payment reform model that includes policies on non-payment for specific services associated with complications that were preventable or services that were unnecessary, for which outcomes are these policies in place? Multi, Checkboxes. 1: N/A, 2: Ambulatory care sensitive admissions, 3: Healthcare acquired conditions (HACs) also known as conditions, 4: Preventable Admissions, 5: Serious Reportable Events (SREs) that are not HACs, 6: Never Events, 7: Early elective induction or cesarean, 8: Other - (provide details in next column) 65 words. 14 Which base payment methodology does your program use? Single, Radio group. 1: Capitation without quality, 2: Salary, 3: Bundled or episode-based payment without quality, 4: FFS (includes discounted fees, fixed fees, indexed fees), 5: Per diem, 6: DRG, 7: Percent of charges, 8: Other - (provide details in next column) 50 words. 15 What types of providers are participating in your program? Describe incentives for participation. Multi, Checkboxes. 1: Primary care physicians, 2: Physician Specialists (e.g., Oncology, Cardiology, etc.) – describe in next column, 3: RNs/NP and other non-physician providers, 4: Hospital inpatient, 50 words. 16
9.4.12.3.9 Indicate the physician/outpatient measures in use for this program. Select all that apply (Note: an expansive list has been provided to facilitate accuracy of reporting, Catalyst for Payment Reform-recommend measures are indicated with*). If using a Composite measure, select composite row and not the individual, underlying measures (e.g., optimal diabetes care) PQRS Measure & Other Measures Level of detail for comparative reporting of physicians who meet the threshold of reliability for reporting. (HMO) Indicate if reporting covers primary care and/or specialty physicians (HMO) Description of Other (if plan selected response option 6) Indicate how measure is used % Physicians receiving award Optimal Diabetes Care Composite* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: HbA1c Poor Control (>9.0%) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Eye Exam Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Percent.
4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) CDC: Hemoglobin A1c (HbA1c) testing Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Foot Exam Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Medical Attention for Nephropathy Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent.
CDC: Blood Pressure Control (<140/80 mm Hg) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Statin Therapy for Patients With Diabetes Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Optimal Cardiovascular Care - Composite Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Controlling High Blood Pressure* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P Percent.
5: ACO, 6: Other (describe), 7: None of the above or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Persistent Beta Blocker Treatment After a Heart Attack Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Statin Therapy for Patients With Cardiovascular Disease* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Cervical Cancer Screening Multi, Checkboxes. 1: Individual Multi, Checkboxes. 50 words. Multi, Checkboxes. 1: Physician Percent.
Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 1: Primary care, 2: Specialty Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Breast Cancer Screening* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Colorectal Cancer Screening* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous of Inappropriate Use* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines Percent. Avoidance
amount of bonus) Preventive Care Screening: Tobacco Use: Screening and Cessation Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Screening Unhealthy Alcohol Use Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Tobacco Screening Use and Cessation Intervention Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, Percent.
model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Other Preventive Care measures Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Use of Imaging Studies for Low Back Pain* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Functional Status Change for Patients with Lumbar Impairments Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent.
CG CAHPS (or Patient Assessment Survey) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Depression Remission at 12 Months Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Depression Remission at 6 Months* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Antidepressant Medication Management* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P Percent.
5: ACO, 6: Other (describe), 7: None of the above or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Screening for Clinical Depression and Plan* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Medication Management for People with Asthma Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. of Antibiotic Treatment in Adults with Acute Bronchitis Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. C-section rate* Multi, Checkboxes. 1: Individual Multi, Checkboxes. 50 words. Multi, Checkboxes. 1: Physician Percent.
Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 1: Primary care, 2: Specialty Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Early elective deliveries or early inductions without medical indication* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Prenatal and Postpartum Care Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Appropriate Treatment for Children with Upper Respiratory Infection* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines Percent.
amount of bonus) NCQA Recognition program certification (consistent with plan response in directory section) (E) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Mortality or complication rates where applicable Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Efficiency (resource use not unit cost) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Pharmacy management (e.g. generic use rate, formulary compliance) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, Percent.
model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Medication Safety Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Health IT adoption/use Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Preventable Readmissions Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent.
amount of bonus) CDC: Hemoglobin A1c (HbA1c) testing Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Foot Exam Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Medical Attention for Nephropathy Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Blood Pressure Control (<140/80 mm Hg) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, Percent.
Persistent Beta Blocker Treatment After a Heart Attack Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Statin Therapy for Patients With Cardiovascular Disease* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Cervical Cancer Screening Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P Percent.
5: ACO, 6: Other (describe), 7: None of the above or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Breast Cancer Screening* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Colorectal Cancer Screening* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous of Inappropriate Use* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Preventive Care Screening: Tobacco Multi, Checkboxes. 1: Individual Multi, Checkboxes. 50 words. Multi, Checkboxes. 1: Physician Percent. Avoidance
amount of bonus) Other Preventive Care measures Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Use of Imaging Studies for Low Back Pain* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Functional Status Change for Patients with Lumbar Impairments Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CG CAHPS (or Patient Assessment Survey) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, Percent.
model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Depression Remission at 12 Months Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Depression Remission at 6 Months* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Antidepressant Medication Management* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent.
Screening for Clinical Depression and Plan* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Medication Management for People with Asthma Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. of Antibiotic Treatment in Adults with Acute Bronchitis Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. C-section rate* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P Percent.
5: ACO, 6: Other (describe), 7: None of the above or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Early elective deliveries or early inductions without medical indication* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Prenatal and Postpartum Care Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Appropriate Treatment for Children with Upper Respiratory Infection* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. NCQA Recognition program certification (consistent with plan Multi, Checkboxes. 1: Individual Multi, Checkboxes. 50 words. Multi, Checkboxes. 1: Physician Percent.
amount of bonus) Medication Safety Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Health IT adoption/use Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Preventable Readmissions Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Preventable ED/ER Visits (NYU) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, Percent.
incentives or disincentives to support the payment reform program. 2: Financial incentives (lower premium, waived/lower co-pays) for members to use COE/higher performance providers, 3: Financial disincentives for members to use non-COE or lower performing providers (e.g., higher etc.), 4: Use of tiered networks, 5: Use of narrow networks, 6: Reference pricing, 7: High deductible health plans, 8: Value-based insurance design, 9: Incentives to select lower cost sites of care (e.g. worksite clinic, retail clinic, telehealth, ambulatory surgery centers), 10: Preauthorization (e.g. "gatekeeper"), 11: Precertification (e.g. health plan approval), 12: Continued stay review, 13: Step therapy, 14: Objective information (e.g., performance measure results) provided on COEs to members, providing evidence of higher-quality care rendered by these providers, 15: Other (please describe) For this payment reform program, do you make information transparent such as performance reports on quality, cost and/or efficiency measures at the provider level? Multi, Checkboxes. 1: We report to the general public, 2: We report to our network providers (e.g. hospitals and physicians), 3: We report to patients of our network providers, 4: We do not report performance on quality measures, 5: We report to state or community data collection processes such as claims databases (APCDs), or AF4Q sites, 6: Other (please describe) 50 words. 21 Describe evaluation and results for program Multi, Checkboxes. 1: Program not evaluated yet, 2: Program evaluation by external third party, 3: Program evaluation by insurer, 4: Evaluation method used pre/post, 5: Evaluation method used matched control group, 6: Evaluation method used randomized control trial, 7: Other evaluation methodology was used (provide details in column to the right) 100 words. 22
reliability for reporting. (HMO) Optimal Diabetes Care Composite* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: HbA1c Poor Control (>9.0%) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Eye Exam Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Hemoglobin A1c (HbA1c) testing Multi, Checkboxes. 1: Individual Physician, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, Percent.
2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) CDC: Foot Exam Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Medical Attention for Nephropathy Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Blood Pressure Control (<140/80 mm Hg) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines Percent.
amount of bonus) Statin Therapy for Patients With Diabetes Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Optimal Cardiovascular Care - Composite Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Controlling High Blood Pressure* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Persistent Beta Blocker Treatment After a Heart Attack Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, Percent.
Breast Cancer Screening* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Colorectal Cancer Screening* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous of Inappropriate Use* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Preventive Care Screening: Tobacco Use: Screening and Cessation Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P Percent. Avoidance
5: ACO, 6: Other (describe), 7: None of the above or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Screening Unhealthy Alcohol Use Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Tobacco Screening Use and Cessation Intervention Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Other Preventive Care measures Multi, Checkboxes. 1: Individual Multi, Checkboxes. 50 words. Multi, Checkboxes. 1: Physician Percent.
Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 1: Primary care, 2: Specialty Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Use of Imaging Studies for Low Back Pain* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Functional Status Change for Patients with Lumbar Impairments Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CG CAHPS (or Patient Assessment Survey) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines Percent.
amount of bonus) Depression Remission at 12 Months Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Depression Remission at 6 Months* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Antidepressant Medication Management* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Screening for Clinical Depression and Plan* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, Percent.
model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Medication Management for People with Asthma Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. of Antibiotic Treatment in Adults with Acute Bronchitis Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. C-section rate* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent.
Early elective deliveries or early inductions without medical indication* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Prenatal and Postpartum Care Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Appropriate Treatment for Children with Upper Respiratory Infection* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. NCQA Recognition program certification (consistent with plan response in directory section) (E) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P Percent.
5: ACO, 6: Other (describe), 7: None of the above or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Mortality or complication rates where applicable Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Efficiency (resource use not unit cost) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Pharmacy management (e.g. generic use rate, formulary compliance) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Medication Safety Multi, Checkboxes. 1: Individual Multi, Checkboxes. 50 words. Multi, Checkboxes. 1: Physician Percent.
Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 1: Primary care, 2: Specialty Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Health IT adoption/use Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Preventable Readmissions Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Preventable ED/ER Visits (NYU) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines Percent.
Optimal Diabetes Care Composite* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: HbA1c Poor Control (>9.0%) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Eye Exam Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Hemoglobin A1c (HbA1c) testing Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P Percent.
5: ACO, 6: Other (describe), 7: None of the above or Shared Risk, 4: P4P Payment (performance determines amount of bonus) CDC: Foot Exam Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Medical Attention for Nephropathy Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. CDC: Blood Pressure Control (<140/80 mm Hg) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Statin Therapy for Patients With Diabetes Multi, Checkboxes. 1: Individual Multi, Checkboxes. 50 words. Multi, Checkboxes. 1: Physician Percent.
Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 1: Primary care, 2: Specialty Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Optimal Cardiovascular Care - Composite Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Controlling High Blood Pressure* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Persistent Beta Blocker Treatment After a Heart Attack Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines Percent.
amount of bonus) Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Statin Therapy for Patients With Cardiovascular Disease* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Cervical Cancer Screening Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Breast Cancer Screening* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, Percent.
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Screening Unhealthy Alcohol Use Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Tobacco Screening Use and Cessation Intervention Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Other Preventive Care measures Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P Percent.
Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 1: Primary care, 2: Specialty Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Depression Remission at 6 Months* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Antidepressant Medication Management* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Screening for Clinical Depression and Plan* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines Percent.
amount of bonus) Medication Management for People with Asthma Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. of Antibiotic Treatment in Adults with Acute Bronchitis Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. C-section rate* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Early elective deliveries or early inductions without medical indication* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, Percent.
model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Prenatal and Postpartum Care Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Appropriate Treatment for Children with Upper Respiratory Infection* Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. NCQA Recognition program certification (consistent with plan response in directory section) (E) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent.
Mortality or complication rates where applicable Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Efficiency (resource use not unit cost) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Pharmacy management (e.g. generic use rate, formulary compliance) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Medication Safety Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P Percent.
5: ACO, 6: Other (describe), 7: None of the above or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Health IT adoption/use Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Preventable Readmissions Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Preventable ED/ER Visits (NYU) Multi, Checkboxes. 1: Individual Physician, 2: Practice Site, 3: Medical Group/IPA/Staff model Group, 4: PCMH, 5: ACO, 6: Other (describe), 7: None of the above Multi, Checkboxes. 1: Primary care, 2: Specialty 50 words. Multi, Checkboxes. 1: Physician Feedback, 2: Physician Feedback with Benchmarking, 3: Threshold Element for P4P or Shared Risk, 4: P4P Payment (performance determines amount of bonus) Percent. Other Measures 500 words. Multi, Checkboxes. 50 words. Multi, Checkboxes. 1: Physician
HOSPITAL CHARGE) of dollar amount listed in column 1 for each row) below of dollar amount listed in column 1 for each row) payment category below of dollar amount listed in column 1 for each row) column) Please select which entities are paid Numerator = $ in specific row C1 Total dollars paid for to Providers for ALL members FOR ALL SERVICES (i.e., services for which there is NO HOSPITAL CHARGE) Dollars. Percent. Percent. Percent. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total 100% 1 Provide the total dollars paid to providers through FFS payments Dollars. N/A OK. Percent. N/A OK. Percent. N/A OK. Percent. N/A OK. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row 2
in CY 2015 or most recent 12 months do not total 100% Provide the total dollars paid to providers through bundled payment programs without quality in CY 2015 or most recent 12 months Dollars. N/A OK. Percent. N/A OK. Percent. N/A OK. Percent. N/A OK. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total 100% 3 Provide the total dollars paid to providers through partial or capitation programs without quality in CY 2015 or most recent 12 months Dollars. N/A OK. Percent. N/A OK. Percent. N/A OK. Percent. N/A OK. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total 100% 4
Provide the total dollars paid to providers through fully capitated programs without quality in CY 2015 or most recent 12 months Dollars. N/A OK. Percent. N/A OK. Percent. N/A OK. Percent. N/A OK. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total 100% 5 Subtotal: Dollars paid out under the status quo: total dollars paid through payment methods in CY 2015 for primary care and specialty services services for which there is NO HOSPITAL CHARGE) For comparison. $0.00 Percent. Percent. Percent. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total 100% 6
[Sum of Rows 2, 3 4 and 5] Provide the total dollars paid to providers through programs with quality in CY 2015 or most recent 12 months Dollars. N/A OK. From 0 to Percent. N/A OK. Percent. N/A OK. Percent. N/A OK. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total 100% 7 Provide the total dollars paid to providers through FFS-based programs with quality in CY 2015 or most recent 12 months Dollars. N/A OK. From 0 to 10000000000000000. Percent. N/A OK. Percent. N/A OK. Percent. N/A OK. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total 100% 8 Provide the total dollars paid to providers Dollars. N/A OK. From 0 to 10000000000000000. Percent. N/A OK. Percent. N/A OK. Percent. N/A OK. Multi, 1: ACO, 2: PCMH, For Unknown 9
through programs with quality CY 2015 or most recent 12 months. 3: Medical Note: provided in this row do not total 100% Provide the total dollars paid to providers through FFS base payments plus (P4P) programs CY 2015 or most recent 12 months Dollars. N/A OK. From 0 to 10000000000000000. Percent. N/A OK. Percent. N/A OK. Percent. N/A OK. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total 100% 10 Provide the total dollars paid to providers through fully capitated payment with quality Dollars. N/A OK. From 0 to 10000000000000000. Percent. N/A OK. Percent. N/A OK. Percent. N/A OK. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total 100% 11
in CY 2015 or most recent 12 months. Provide the total dollars paid to providers through partial or capitation programs with quality in CY 2015 or most recent 12 months Dollars. N/A OK. From 0 to 10000000000000000. Percent. N/A OK. Percent. N/A OK. Percent. N/A OK. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total 100% 12 Provide the total dollars paid to providers through bundled payment programs with quality CY 2015 or most recent 12 months Dollars. N/A OK. From 0 to 10000000000000000. Percent. N/A OK. Percent. N/A OK. Percent. N/A OK. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total 100% 13
Percentage Percentage Percentage Provide the total dollars paid for FFS-based non-visit functions. (see for in CY 2015 or most recent 12 months. Dollars. N/A OK. From 0 to 10000000000000000. Percent. N/A OK. Percent. N/A OK. Percent. N/A OK. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total 100% 14 Provide the total dollars paid for non-visit functions. (see for in CY 2015 or most recent 12 months. Dollars. N/A OK. From 0 to 10000000000000000. Percent. N/A OK. Percent. N/A OK. Percent. N/A OK. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total 100% 15 Provide the total dollars paid to providers whose contract contains other types of Dollars. N/A OK. From 0 to 10000000000000000. Percent. N/A OK. Percent. N/A OK. Percent. N/A OK. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row 16 )
incentive program not captured above and NOT based on FFS do not total 100% Total dollars paid to payment reform programs based on FFS. For comparison. $0.00 Percent. Percent. Percent. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total one hundred percent 17 Total dollars paid to payment reform programs NOT based on FFS. For comparison. $0.00 Percent. Percent. Percent. Multi, 1: ACO, 2: PCMH, 3: Medical For Unknown Note: provided in this row do not total one hundred percent 18 9.4.12.7.1.2 Based on your responses above, on an aggregate basis for the plan’s book of business in the market of your response, indicate the relative weighting or allocation of the Plan's financial incentives for outpatient services (no associated hospital charges), and which payment approaches, if any, the Contractor is using currently to tie payment to performance. If the relative weighting varies by contract, describe the most prevalent allocation. The Plan's response should total 100.00% within each column. Enter 0.00% if incentives not used. Estimate of allocation of Product where Type of Payment Approach Description of other Percentage Percentage
(HACs) also known as conditions that were preventable or services that were unnecessary, 11: Other non-FFS based payment reform models (provide details in next column) Improvement over time of Outcomes and/or Process measures Percent. Single, Pull-down list. 1: HMO, 2: PPO, 3: Both HMO and PPO, 4: Not available Multi, Checkboxes. 1: Shared-risk (other than bundled payment) and/or gainsharing with quality, 2: FFS-based Shared-savings with quality, 3: Non-FFS-based with quality, 4: FFS plus pay for performance, 5: Full capitation with quality, 6: Partial or condition-specific capitation with quality, 7: Bundled payment with quality, 8: FFS-based non-visit functions, 9: Non-FFS-based non-visit functions, 10: Non-payment for specific services associated with healthcare acquired conditions (HACs) also known as conditions that were preventable or services that were unnecessary, 11: Other non-FFS based payment reform models (provide details in next column) 65 words. PATIENT SAFETY (e.g., Leapfrog, AHRQ, medication related safety issues) Percent. Single, Pull-down list. 1: HMO, 2: PPO, 3: Both HMO and PPO, 4: Not available Multi, Checkboxes. 1: Shared-risk (other than bundled payment) and/or gainsharing with quality, 2: FFS-based Shared-savings with quality, 3: Non-FFS-based with quality, 4: FFS plus pay for performance, 5: Full capitation with quality, 6: Partial or condition-specific capitation with quality, 7: Bundled payment with quality, 8: FFS-based non-visit functions, 9: Non-FFS-based non-visit 65 words. acquired acquired endorsed
5: Full capitation with quality, 6: Partial or condition-specific capitation with quality, 7: Bundled payment with quality, 8: FFS-based non-visit functions, 9: Non-FFS-based non-visit functions, 10: Non-payment for specific services associated with healthcare conditions (HACs) also known as conditions that were preventable or services that were unnecessary, 11: Other non-FFS based payment reform models (provide details in next column) Health IT adoption or use Percent. Single, Pull-down list. 1: HMO, 2: PPO, 3: Both HMO and PPO, 4: Not available Multi, Checkboxes. 1: Shared-risk (other than bundled payment) and/or gainsharing with quality, 2: FFS-based Shared-savings with quality, 3: Non-FFS-based with quality, 4: FFS plus pay for performance, 5: Full capitation with quality, 6: Partial or condition-specific capitation with quality, 7: Bundled payment with quality, 8: FFS-based non-visit functions, 9: Non-FFS-based non-visit functions, 10: Non-payment for specific services associated with healthcare conditions (HACs) also known as conditions that were preventable or services that were unnecessary, 11: Other non-FFS based payment reform models (provide details in next column) 65 words. Financial results Percent. Single, Pull-down list. 1: HMO, 2: PPO, 3: Both HMO Multi, Checkboxes. 1: Shared-risk (other than bundled payment) and/or gainsharing with quality, 2: FFS-based Shared-savings with quality, 65 words. acquired acquired
Program 1 Other markets/details for Program 1 Row Number Name of Payment Reform Program and Name and contact details (email and phone) of contact person who can answer questions about program being described 65 words. N/A 1 Contact Name for Payment Reform Program (person who can answer questions about the program being described) 5 words. N/A 2 Contact Person's Title 5 words. N/A 3 Contact Person's Email 5 words. N/A 4 Contact Person's Phone 5 words. N/A 5 Contact Name for person who is authorized to update this program entry in ProposalTech after Contractor has submitted response (if same as contact name for the payment reform program, please reenter his/her name) 5 words. N/A 6 Email for person authorized to update this program entry in ProposalTech after Contractor has submitted response (if same as contact email for the payment reform program, please reenter his/her email) 5 words. N/A 7 Geographic Covered California region of named payment reform program (Ctrl-Click for multiple states) Single, Radio group. 1: Not in this market (Identify market in column to the right), 2: In this market and other markets (Identify market(s) in column to the right), 3: Only in this market Multi, List box. 1: Alpine, Del Norte, Siskiyou, Modoc, Lassen, Shasta, Trinity, Humboldt, Tehama, Plumas, Nevada, Sierra, Mendocino, Lake, Butte, Glenn, Sutter, Yuba, Colusa, Amador, Calaveras, and Tuolumne, 2: Napa, Sonoma, Solano, and Marin, 3: Sacramento, Placer, El Dorado, and Yolo, 4: San Francisco, 5: Contra Costa, 6: Alameda, 8
Please specify which provider types (e.g. specialists, primary care physicians, etc.) assume financial risk (if any) in the program. Multi, Checkboxes. 1: PCPs, 2: Specialists (detail), 3: Provider group, 4: Hospitals, 5: Joint physician/hospital ACO, 6: N/A If provider types list above are not applicable, explain financial risk. 200 words. 9.4.12.9.8 Indicate if the following alternative payment model is included in the program specified above: Bundled Payment/ Episode-Based Payment Response Program includes bundled payment. Single, Pull-down list. 1: Yes, 2: No Please list for which clinical conditions or episodes of care the program makes bundled payments to providers and then respond to the questions below for each of the clinical conditions or episodes of care listed. Unlimited. What health care services related to the condition or episode of care are not covered by the bundled payment? Unlimited. Identify the characteristics of the bundled payment program. Multi, Checkboxes. 1: Cost for complications, readmissions, or other such related services included, 2: Bundled payment amount is set below the estimated FFS cost for the same services., 3: Payment amount risk-adjusted, 4: None of the above, 5: Other (explain) Is there an expressed warranty period (e.g. 90 day period within which all complications are addressed)? If yes, indicate pre- and post-period; if no indicate N/A 100 words. N/A OK. If the program pay providers prospectively, please describe the trigger event. 100 words. N/A OK. If the program reconciles the bundled payment retrospectively, please describe how the program pays providers during the course of care (e.g. FFS, capitation) and the reconciliation process. 100 words. N/A OK.
9.4.12.9.9 Indicate the inpatient measures in use for this program. Select all that apply (Note: an expansive list has been provided to facilitate accuracy of reporting, Catalyst for Payment Reform-recommend measures are indicated with*). where Entity Paid Type of of Other how is used % HQA ACUTE MYOCARDIAL INFARCTION (AMI) Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus)
HEART FAILURE (HF) Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled with quality, 8: non-visit 9: 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus) savings savings
non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based reform models in next column) PNEUMONIA (PNE) Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P savings savings
in next column) Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled with quality, 8: 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus) savings savings
non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based reform models in next column) Surgical Infection Prevention/ Surgical Care Improvement Project (SCIP) Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P savings
based reform models in next column) PATIENT EXPERIENCE/H-CAHPS Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus) savings savings
with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based reform models in next column) LEAPFROG Safety Practices Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P
with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were or Shared Risk, 4: P4P amount of bonus) savings savings
11: Other non-FFS based reform models in next column) Leapfrog Hospital Safety Score Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus) savings savings
services that were 11: Other non-FFS based reform models in next column) Management of Patients in ICU Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus) savings savings
group, 4: Other and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled with quality, 8: non-visit 9: non-visit 10: policy for specific services with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus) savings savings
that were or services that were 11: Other non-FFS based reform models in next column) Adoption of NQF Safe Practices Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus) savings savings
2: ACO, 3: or group, 4: Other (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled with quality, 8: non-visit 9: non-visit 10: 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus) savings savings
policy for specific services that were or services that were 11: Other non-FFS based reform models in next column) Maternity –elective c-section rates Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus) savings savings
Maternity – Healthy Term Newborn Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled with quality, 8: non-visit 9: 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus) savings savings
non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based reform models in next column) HOSPITAL QUALITY INSTITUTE HOSPITAL ENGAGEMENT NETWORK Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P savings savings
with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based reform models amount of bonus)
in next column) CAUTI Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled with quality, 8: 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus) savings savings
non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based reform models in next column) CLABSI Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P savings
11: Other non-FFS based reform models in next column) AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)* Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus)
quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or Element for P4P or Shared Risk, 4: P4P amount of bonus)
services that were 11: Other non-FFS based reform models in next column) Patient safety indicators Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus)
specific with quality, 7: Bundled with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based reform models in next column) Prevention quality indicators Multi, 1: 2: ACO, 3: or Multi, 1: (other than bundled 65 Multi, 1: Hospital 2: Hospital
group, 4: Other and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled with quality, 8: non-visit 9: non-visit 10: policy for specific services with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus)
that were or services that were 11: Other non-FFS based reform models in next column) OTHER MEASURES Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 65 Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P amount of bonus)
2: ACO, 3: or group, 4: Other (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled with quality, 8: non-visit 9: non-visit 10: list.
policy for specific services that were or services that were 11: Other non-FFS based reform models in next column) SREs (serious reportable events) that are not HACs (e.g., surgery on the wrong body part or wrong patient) www.qualityforum.org/Topics/SREs/List_of_SREs.aspx . Please refer to attachment Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for list. list. risk
Admissions; Admissions per 1,000 for defined populations) 1: 2: ACO, 3: or group, 4: Other 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled with quality, 8: non-visit 9: list. list. risk
non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based reform models in next column) Readmissions Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, list. list. risk
9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based reform models in next column) MORTALITY MEASURES (AMI, HF and Pneumonia mortality measures) Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: list. list. risk
reform models in next column) ICU Mortality Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled with list. list. risk
7: Bundled with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based reform models in next column) Osteoarthritis- Hospital-Level Risk-Standardized Complication Rate Following Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty Multi, 1: 2: ACO, 3: or group, 4: Other Multi, 1: (other than bundled and/or with quality, list. list.
1: 2: ACO, 3: or group, 4: Other 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled with quality, 8: non-visit 9: non-visit list. list.
13: Mono, Inyo, and Imperial, 14: Kern, 15: Los Angeles County ZIP Codes starting with 906 to 912, inclusive, 915, 917, 918, and 935, 16: Los Angeles County ZIP Codes in other than those identified above, 17: San Bernardino and Riverside, 18: Orange, 19: San Diego In 500 words or less, please provide a general description of the program, including its goals, how it represents an advance, and any high-level results to date (attachments permitted). 500 words. N/A 9 Identify the line(s) of business for which this program is available? Multi, Checkboxes. 1: Self-insured commercial, 2: Fully-insured commercial, 3: Medicare, 4: Medicaid, 5: Other – please describe in next column 50 words. 10 Identify the product(s) for which this program is integrated Multi, Checkboxes. 1: PPO, 2: POS, 3: EPO, 4: HMO, 5: HDHP, 6: Other (please describe in next column) Unlimited. 11 What is current stage of implementation. Provide date of implementation in detail column Single, Radio group. 1: Planning mode, 2: Pilot mode (e.g. only available for a subset of members and/or providers), 3: Expansion mode (e.g. passed initial pilot stage and broadening reach), 4: Full implementation (e.g. available to all intended/applicable providers and members) To the day. 12 Which alternative payment model(s) most accurately describe(s) the payment reform program? Check all that apply. Note most dominant in next column Multi, Checkboxes with 50 words. 1: Shared-risk (other than bundled payment) and/or gainsharing with quality, 2: FFS-based Shared-savings with quality, 3: Non-FFS-based Shared-savings with quality, Multi, List box. 1: Of payment models selected in previous column, note dominant model in detail box in cell 13
Entity Paid Type of of Other how is used % HQA ACUTE MYOCARDIAL INFARCTION (AMI) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) HEART FAILURE (HF) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with 65 words. Multi, 1: Hospital 2: Hospital with
11: Other non-FFS based payment reform models (describe in next column) PNEUMONIA (PNE) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform 4: P4P Payment amount of bonus)
models (describe in next column) LEAPFROG Safety Practices Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Leapfrog Hospital Safety Score Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment
in next column) Adoption of CPOE Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Management of Patients in ICU Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment
Evidence-Based Hospital referral indicators Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Adoption of NQF Safe Practices Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Maternity – Healthy Term Newborn Multi, 1: Hospital, 2: ACO, 3: Multi, 1: (other 65 words. Multi, 1: Hospital
Physician or physician group, 4: Other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
were or services that were 11: Other non-FFS based payment reform models (describe in next column) HOSPITAL QUALITY INSTITUTE HOSPITAL ENGAGEMENT NETWORK Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
that were 11: Other non-FFS based payment reform models (describe in next column) CLABSI Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Surgical site infections (SSI) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: 65 words. Multi, 1: Hospital 2: Hospital with 3:
11: Other non-FFS based payment reform models (describe in next column) Adverse drug events (ADE) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)* Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or
quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based Shared Risk, 4: P4P Payment amount of bonus)
payment reform models (describe in next column) Inpatient quality indicators Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Patient safety indicators Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment
in next column) Prevention quality indicators Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) OTHER MEASURES Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment
HACs – hospital conditions (e.g., Surgical site infection following coronary artery bypass graft Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) SREs (serious reportable events) that are not HACs (e.g., surgery on the wrong body part or wrong patient) www.qualityforum.org/Topics/SREs/List_of_SREs.aspx . Please refer to attachment Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
that were 11: Other non-FFS based payment reform models (describe in next column) HIT adoption/use Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
11: Other non-FFS based payment reform models (describe in next column) Osteoarthritis- Hospital-Level Risk-Standardized Complication Rate Following Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based Shared Risk, 4: P4P Payment amount of bonus)
payment reform models (describe in next column) Low Back Pain- Use of Imaging Studies for Low Back Pain Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
in next column) Rate of hospital-level observation stays Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Rate of use of inappropriate care (select a measure for reporting) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment
Other standard measures by National Quality Forum (describe): Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
Entity Paid Type of of Other how is used % HQA ACUTE MYOCARDIAL INFARCTION (AMI) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
11: Other non-FFS based payment reform models (describe in next column) PNEUMONIA (PNE) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element
8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) PATIENT EXPERIENCE/H-CAHPS Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk,
models (describe in next column) LEAPFROG Safety Practices Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
in next column) Adoption of CPOE Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Management of Patients in ICU Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment
4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) amount of bonus)
Evidence-Based Hospital referral indicators Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Adoption of NQF Safe Practices Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Maternity –elective c-section rates Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
Physician or physician group, 4: Other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
were or services that were 11: Other non-FFS based payment reform models (describe in next column) HOSPITAL QUALITY INSTITUTE HOSPITAL ENGAGEMENT NETWORK Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
that were 11: Other non-FFS based payment reform models (describe in next column) CLABSI Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
11: Other non-FFS based payment reform models (describe in next column) Adverse drug events (ADE) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
payment reform models (describe in next column) Inpatient quality indicators Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Patient safety indicators Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment
non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) OTHER MEASURES Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment
1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Readmissions Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
Physician or physician group, 4: Other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
were or services that were 11: Other non-FFS based payment reform models (describe in next column) MORTALITY MEASURES (AMI, HF and Pneumonia mortality measures) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
that were 11: Other non-FFS based payment reform models (describe in next column) HIT adoption/use Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
11: Other non-FFS based payment reform models (describe in next column) Osteoarthritis- Hospital-Level Risk-Standardized Complication Rate Following Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
in next column) Rate of hospital-level observation stays Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
Other standard measures by National Quality Forum (describe): Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
Entity Paid Type of of Other how is used % HQA ACUTE MYOCARDIAL INFARCTION (AMI) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
11: Other non-FFS based payment reform models (describe in next column) PNEUMONIA (PNE) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element
with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other for P4P or Shared Risk, 4: P4P Payment amount of bonus)
non-FFS based payment reform models (describe in next column) Surgical Infection Prevention/ Surgical Care Improvement Project (SCIP) Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
8: non-visit 9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) PATIENT EXPERIENCE/H-CAHPS Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk,
models (describe in next column) LEAPFROG Safety Practices Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: with quality, 4: FFS plus pay for 5: Full with quality, 6: Partial or specific with quality, 7: Bundled payment with quality, 8: non-visit 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment amount of bonus)
9: non-visit 10: policy for specific services that were or services that were 11: Other non-FFS based payment reform models (describe in next column) Leapfrog Hospital Safety Score Multi, 1: Hospital, 2: ACO, 3: Physician or physician group, 4: Other Multi, 1: (other than bundled and/or with quality, 2: with quality, 3: 65 words. Multi, 1: Hospital 2: Hospital with 3: Element for P4P or Shared Risk, 4: P4P Payment