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AHCAHP Conference Presentations

Methods to Pay CHC Providers Based on Quality.

OVERVIEW

Over the past several years, Neighborhood Plan of Rhode Island (NHPRI) has developed Community Health Center (CHC) based provider incentives targeted at addressing quality of care.

Currently, NHPRI’s contractual arrangement provides for incentives based on Health Plan Employer Data Information Sets (HEDIS) measures of Effectiveness of Care and Access/Availability of Care. When HEDIS is prepared each year, the clinical program incentives are “over sampled” in order to provide for statistically accurate measurement.

The following clinical program incentives have been effective since September 1, 1999 and will remain in effect through December 31, 2002.

Clinical Program Incentives NHPRI Planwide Thresholds Incentives
  1999 2000 2001 1999 2000 2001
Childhood Immunization
(Combo 1) 		58% 75% 72% N/A 70% 70%
Adolescent Immunization
(MMR only) 		71% 80% 85% N/A 75% 80%
Cervical Cancer 74% 77% 75% N/A 75% 80%
Adult Access to Care
(Ages 20-44) 		82% 80% 81% N/A 85% 80%

Each clinical program incentive has a targeted threshold (see table above), which triggers the incentive payment. Payment is based on a pre-set PMPM and membership for a set period of time. These thresholds are set for the term of the contract and are reviewed annually during contract negotiations with the CHCs.

LESSONS LEARNED:

  • Clinical program incentives tie directly to CHC’s and NHPRI’s missions.

  • Joint setting of thresholds allows for cooperative learning environment.

  • To be effective, clinical program incentives need to stay constant over a period of several years.

  • Presentation of comparative data across CHCs encourages conversations and best practice sharing and some competitiveness.

  • While clinical program incentives encourage results, they are not the only driver, but they do help!

  • Keeping the clinical program incentives simple helps with ease of administration and understanding by all – including CHC and NHPRI staff.

  • Clinical program incentives based on accepted measurements – like HEDIS – are more easily acceptable to CHCs.

  • CHC’s performances on preventive care HEDIS measures outperform NHPRI network and continue to improve year after year.

OTHER COMPLIMENTARY INCENTIVE PROGRAMS:

  • Data Integrity

  • Patient Encounter Cycle Time (Bureau of Primary Health Care sponsored Appointment Cycle Time Breakthrough Series)