|Illinois Paying Doctors Bonuses For Providing Quality Care
The Illinois Department of Healthcare and Family
Services (HFS) paid approximately $5 million in incentives to
physicians who treated patients enrolled in the state’s Health
Connect program – a primary care case management program
administered by HFS – in 2008. Payment figures for 2009
weren’t available yet.
The physicians met or exceeded national performance standards in caring for 1.6 million low-income residents.
"We think it’s an extremely wise investment for
the overall future health of Illinois citizens," said Illinois HFS
Director Barry Maram.
HFS evaluated the performance of more than 5,000 primary
care physicians, focusing on five areas critical for promoting public
health: child immunizations, child developmental screenings,
asthmamanagement, diabetes management and breast cancer screening.
To qualify for bonuses, physicians must meet or exceed
standards established by the Healthcare Effectiveness Data and
Information Set (HEDIS).
Under terms of the P4P plan, a qualifying primary care
physician could receive multiple bonus payments for multiple
HFS collaborated with Ingenix, a health information and
consulting services company and a subsidiary of UnitedHealth Group.
Ingenix developed measurements and analyzed physician performance based
on claims and immunization data, as well as other demographic
Data mining and analysis, conducted using HFS’
Medicaid data warehouse, was implemented by Ingenix to help manage the
Illinois Medicaid program, one of the nation’s top 10 public
health plans based on the number of beneficiaries.
In diabetes management doctors received an incentive
payment of at least $20 for each patient that met the diabetes
management criteria. If fewer than 79 percent of Health Connect
patients on the doctor’s roster did not have the test, the
doctors weren’t paid.
In the other areas, the benchmarks for physician bonus payments in Illinois are:
- Child immunizations: At least 62 percent of
enrolled two-year-old children are required to be immunized with the
correct combinations of vaccines for childhood diseases.
- Child developmental screenings: At least 35
percent of children are required to be screened by the age of 12
months; 25 percent must receive at least one developmental screening
between the ages of 12 months and 24 months; and 20 percent must
receive at least one developmental screening between the ages of 24
months and 36 months.
- Asthma management: Nearly 92 percent of
patients between the ages of 5 and 9 must be on an appropriate
controller medication; 89 percent of patients between the ages of 10
and 17 must be on an appropriate controller medication; and 85 percent
of patients between the ages of 18 and 56 must be on an appropriate
- Breast cancer screening: At least 49 percent
of women between the ages of 40 and 69 must have had a mammogram to
screen for breast cancer in the measurement year or the year prior.
Address: Illinois Department of Healthcare and Family
Services, 201 South Grand Avenue East, Springfield, IL 62763-0001;
(217) 782-1200, www.hfs.illinois.gov.