At Gateway Health Plan^®, we value the important role practitioners play in serving our members. We support recognizing and rewarding performance for those practices committed to providing quality healthcare that is accessible and efficient. Therefore, working collaboratively with the Department of Public Welfare (DPW) Gateway would like to welcome you to the enhanced 2012 Gateway to Practitioner Excellence Program. This program supports Gateway’s mission to deliver quality programs that positively impact the personal health of its members.

• Consistent clinical quality measures among Pennsylvania Managed Care Organizations
• Expansion to dentists and Obstetrical (OB) Care Providers
• Addition of dental and OB measures
• Addition of quarterly award payments for individual preventive services including the use of in-office HbA1c testing
• Addition of annual award payments for PCP practices’ pediatric dental visit rates

Who is eligible for the program?

• High volume primary care physician practices (Family Practice, Internal Medicine, and Pediatrics) with panel size of 200 or more members
• Obstetrical Care Providers (panel size not required)
• Dentists (panel size not required)

Clinical Quality Measures

*Reported and Paid Quarterly ± Reported and Paid Annually ■ Indicates New Measure

• 4/30/12 for dates of service 1/1/12 – 3/31/12 paid through 3/31/12
• 7/31/12 for dates of service 1/1/12 – 6/30/12* paid through 6/30/12
• 10/31/12 for dates of service 1/1/12 – 9/30/12* paid through 9/30/12
• 1/31/13 for dates of service 1/1/12 – 12/31/12* paid through 12/31/12
• 4/30/13 final payment for dates of service 1/1/12 – 12/31/12 paid through 3/31/13 which includes a three-month claims lag from 1/1/13 – 3/31/13

Annual Award (based on rates)
    The annual award payment schedule is as follows:

• 4/30/13 final payment for dates of service 1/1/12 – 12/31/2 paid through 3/31/13 which includes a three-month claims lag from 1/1/13 – 3/31/13

Obstetrical Care Providers Award
Obstetrical Care providers will be awarded based on submission of the OB Needs Assessment Form (ONAF) and a bonus if submitted in the first trimester; submission of each prenatal visit completed and submission of the postpartum visit.

 Scoring Methodology for Annual Measures
Gateway uses a member-centered approach to attribute patients to specific practices. If a member changes to a new practice during the measurement period, then that member will be attributed to both practices. Physician practices are scored in relation to national Medicaid rates published by the National Committee for Quality Assurance (NCQA). All measures use encounter data (inpatient, outpatient, laboratory, and pharmacy).

Scorecard
Scores are measured, reported, and awarded at the practice level. Gateway will provide a scorecard to participating practices for the annual measures which include:

• Practice eligible measures,
• Practice level numerator, denominator, and rate for each measure,
• Measure definitions and scoring methodology.