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MedNet would like to introduce you to Harvard Pilgrim Health Care’s new "Rewards
for Excellence" program. Beginning in 2003, HPHC will recognize and reward exemplary
performance achieved by local physicians and physician groups. The following categories
will be measured of MedNet physicians by HPHC:
- Diabetes 1: HbA1c
Percentage of members with diabetes (Type 1 and Type 2) age 18 – 75 who were continuously enrolled during the measurement year, who had a HbA1c test.
- Diabetes 2: Eye Exam
Percentage of members with diabetes (Type 1 and Type 2) age 18 – 75 who were continuously enrolled during the measurement year, who had a retinal eye exam.
- Diabetes 3: Cholesterol Screening
Percentage of members with diabetes (Type 1 and Type 2) age 18 – 75 who were continuously enrolled during the measurement year, who had an LDL-C test.
- Diabetes 4: Nephropathy Screening*
Percentage of members with diabetes (Type 1 and Type 2) age 18 – 75 who were continuously enrolled during the measurement year, who had kidney disease monitored.
- Depression: Optimal Practitioner Contacts for New Medication Management (18+)
Percentage of members who were diagnosed with a new episode of depression, treated with antidepressant medication, and who had at least three follow-up contacts with a PCP or behavioral health provider coded with a mental health diagnosis during the 84 day acute treatment phase.
- Chlamydia Testing (ages 16-26)
Percentage of women (age 16 – 26) who were identified as sexually active, who were continuously enrolled during the measurement year and who had at least one test for Chlamydia during the measurement year. The criteria for sexually active is derived from pharmacy data (contraceptives) or from encounter data related to contraceptive procedures, tubal ligations, IVF procedures, childbirth-related procedures, abortion procedures, D&Cs, OB Ultrasound, fetal echoes, pregnancy related lab work and pathology.
* Acceptable tests for Nephropathy Screening (Microalbuminuria) include:
- 82042 – Albumin Serum, urine, quantitative
- 82043 – Albumin serum, urine, microalbumin, quantitative
- 82044 – Albumin serum, urine, microalbumin, semi-quantitative (e.g. reagent strip assay)
- 84155+ – Protein; Total, except refractometry
- 84160+ – Protein, Total, regractometric
- 84165+ – Protein, Total, electgrophoretic fractionation and quantitation
+ code must be accompanied by CPT code 81050 to indicate test was urinalysis
The above measures have been defined by the Health Plan Employer Data and Information
Set (HEDIS®) program of the National Committee for Quality Assurance (NCQA).
The measures will be obtained from claims-based data, consistent with how HEDIS
collects data to rate health plans. The dollar amount of the reward will depend on
the size of our membership and how many of the targets we achieve. The performance
threshold for receiving an award is set by Harvard Pilgrim, at the National HEDIS 90th
percentile level. Each diabetes measure is rewarded at $0.25 per member per month
(PMPM). Antidepressant follow-up and Chlamydia testing measures are each rewarded at
$0.50PMPM.
HPHC’s 2002 HEDIS report shows that MedNet would have earned reward dollars for all
of the diabetes measures except nephropathy testing. Chlamydia testing was well below
the target level, and too few patients were identified in the antidepressant category
to be counted. Had the program been in effect last year, MedNet physicians would have
earned a total of $41,500. Monies earned in 2003, beyond the cost of implementing
this program, will be distributed to MedNet providers based on performance measures,
in process of being defined. Additional information and updates on program performance
will be distributed throughout the year.
Last Year’s Scores
 |
|
HEDIS 2002 |
|
Performance Measure |
# Cases |
Score |
Target Score |
|
Diabetes: HbA1c Testing |
160 |
97.97 |
89.96 |
J |
Diabetes: Eye Exam |
160 |
73.11 |
69.59 |
J |
Diabetes: Cholesterol |
160 |
88.91 |
88.89 |
J |
Diabetes: Nephropathy |
160 |
54.15 |
65.45 |
J |
New Antidepressant Rx Management |
34 |
small n |
50.00 |
J |
Chlamydia, Ages 16 – 26 |
155 |
19.84 |
50.00 |
L |
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