Gateway to Physician ExcellenceSM (GPESM) Program
Thanks to you, our first year of the 2008 Gateway to Physician ExcellenceSM (GPESM) Program was a success. This program which involved 313 primary care practices (Family Practice, Internal Medicine and Pediatric Practices) across the State of Pennsylvania. This impacted over 1150 primary care practices and provided care to 76% (185,374) of Gateway’s Medicaid membership. Practice participation in GPESM is noted in both the provider directory and online provider directory.
Based on our first year’s experience, the 2009 program criteria and design will remain unchanged in order to establish a solid baseline for year to year comparison. We are delighted with the outpouring of interest in the program and look forward to continue to engage physician practices throughout 2009.
For more information on the 2009 program, please refer to the GPESM Program information by clicking on the content links below. There will be information in upcoming newsletter articles. You may also contact your Provider Relations Representative.
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 provide care to 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;
- This measure is not used in calculating final performance score or the award amount but is intended to provide feedback and encouragement for providers to submit complete and accurate 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 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 2008 performance will be distributed late in 2009.
Recognition
In addition to financial awards, Gateway to Physician ExcellenceSM practice participation is noted in both the provider directory and the online provider directory.
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?
Look for future updates, upcoming newsletter articles and program educational materials.
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