|Medica P4P Program Rewards Providers More Than $3 Million
Medica in the past year has paid more than $3 million to
providers in its network for improvements in the clinical care provided
to the health plan’s members.
The payments are associated with improvements to
clinical outcomes related to Medica’s pay-for-performance (P4P)
program during the 2007 calendar year. The reward payments are over and
above the reimbursements Medica pays to providers based on claims for
providing care to its members.
The program is designed to assess the efficiency and
quality related to certain areas of clinical care. Measurements assess
how well chronic conditions like asthma and diabetes are managed, and
the rate at which routine preventive services and exams are performed
by providers participating in the program.
Additional incentives reward providers driving care improvements and achieving evidence-based outcomes.
For 2007, the clinical component of Medica’s P4P
program focused on asthma, Chlamydia screening, diabetes, generic drug
prescribing, well-child examinations, childhood immunizations,
mammography, Pap tests as well as participation in Medica’s high
tech imaging program.
To qualify for a P4P payout, for example, a provider
participating in diabetes management would need to show an improvement
in the number of members with diabetes who met criteria for optimally
managed care. Optimally managed care for diabetics focuses on five
treatment goals that, when achieved together, represent the highest
standard for managing diabetes.
Reaching all five goals greatly reduces a patient’s risk for the cardiovascular problems associated with diabetes.
The goals are:
- blood sugar that is under control;
- blood pressure in the normal range;
- healthy cholesterol levels;
- daily aspirin use for persons ages 18-75; and
- a tobacco-free lifestyle.
Similar standards are used to measure quality and efficacy in other areas of care in the program.
Altogether, more than $2,207,476 has been sent to providers who participated in the clinical programs.
Medica also paid $915,500 to providers for developing
clinical practices that result in improved care and have evidence-based
outcomes. Care improvement payments were made to providers through the
Medica Raising the Bar Innovation Awards and its Clinic-Based Chronic
Care Management programs. Raising the Bar Innovation Awards recognize
the work of provider groups — from single-site practices to
healthcare systems — that are implementing unique changes that
improve patient care and have proven results, through measures of
clinical outcomes or effectiveness.
Clinic-Based Chronic Care Programs focus on the whole
person who has or is at risk for a chronic disease, taking into account
such things as lifestyle, prevention and physical and behavioral
health. Proven behavior change methods are used and each person’s
level of engagement is determined by their desire to work on changes in
behavior that will improve their health or lower their risk of disease.
"Medica’s pay-for-performance program demonstrates
the high value we place on improving the care delivered to our
members," said Dr. Charles Fazio, Medica’s chief medical officer.
"It shows that when we focus on the right care at the right time and
place we can achieve outcomes that are better for patients, have lower
cost and stronger partnerships between Medica and our provider network.
We are delighted to provide incentives when everyone benefits."
Address: Medica, P.O. Box 9310, Minneapolis, MN 55440; (952) 992-2900, www.medica.com.