Gateway Health Plan® Introduces New Pay for Performance Program
At Gateway Health Plan®, we value the important role physicians play in serving our members. We believe that physician practices committed to providing quality healthcare that is accessible and efficient should be recognized and rewarded for their performance. Therefore, working collaboratively with physician advisors, Gateway Health Plan® has designed and implemented an innovative pay for performance (P4P) program, Gateway to Physician ExcellenceSM. This program is aligned with the Prescription for Pennsylvania goals and the DPW's MCO P4P Program. Gateway to Physician ExcellenceSM supports Gateway's mission to deliver quality programs that positively impact the personal health of its members.
Gateway to Physician ExcellenceSM (GPESM) strives to:
- Improve the delivery of healthcare – including quality, access, and efficiency,
- Reduce racial and ethnic disparities,
- Improve the member experience, and
- Increase physician satisfaction.
Who is Eligible?
- High volume primary care physician practices (minimum of 200 members),
- Including Family Practice, Internal Medicine, and Pediatrics.
- These physicians touch approximately 76% of Gateway members.
Performance Measures
Gateway to Physician ExcellenceSM focuses on data driven measures to evaluate practice performance in the areas of Clinical Quality, Emergency Room Avoidance, and Encounter Data Submission.
Clinical Quality
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Women's Health
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Diabetes Care
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Asthma
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Pediatric Care
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Cardiovascular Care
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Emergency Room Avoidance
Encounter Data Submission
- Supports current and future performance assessments;
- Measurement not used in calculating final score or award; intended to
- Provide feedback and encouragement for providers to submit encounters.
Scoring Methodology, Scorecard, Awards, and Recognition
Scoring Methodology
Gateway uses a member-centered approach to assign the responsibility of treating patients to specific practices. If a member changes to a new assigned practice during the measurement period, then that member will be attributed to multiple practices. Physician practices are scored in relation to other practices.
All measures leverage encounter data (inpatient, outpatient, laboratory, and pharmacy). This eliminates the practice burden to self-report data through surveys or medical chart reviews.
Scorecard
Scores are measured, reported, and awarded at the practice level. Gateway will provide a scorecard to participating practices detailing:
- Practice eligible measures,
- Practice level numerator, denominator, and rate for each measure,
- Measure definitions and scoring methodology,
- Accessibility and availability factors, and
- Encounter submission rate.
Scorecards will be hand delivered to allow discussion of performance improvement opportunities.
Gateway to Physician ExcellenceSM is designed to recognize and reward practice quality. The financial award is a function of four factors – final practice performance across all measures, practice member volume, practice access and availability, and the annually established Gateway to Physician ExcellenceSM program budget. Annual award payments will be separate from physician base payments. The awards for 2007 performance will be distributed late in 2008.
Recognition
In addition to financial awards, Gateway to Physician ExcellenceSM practice participation is noted in both the provider directory and the online provider search tool.
Physician Involvement
Gateway assures that the physician community is involved by engaging GPESM enrolled physicians, QI/UM Committee and Physician Portfolio Workgroup members in the ongoing program development. These physicians, representing the interest of a wide range of stakeholders, have provided clinical input throughout the program design process.
Want More Information?
In the spring of 2008 Representatives from Gateway Health Plan ® will be meeting with eligible physician practices through on site and town hall meetings to describe the program in more detail. Look for future updates at www.gatewaywayhealthplan.com/gpe, upcoming newsletter articles and program education materials.
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