Overview

The fundamental principles of Pay for Performance are: (1) Common performance measures for physician groups (developed collaboratively by health plan and physician group medical directors, researchers, and other industry experts); and (2) Significant health plan financial payments based on that performance (with each plan independently deciding the source, amount and payment method for its incentive program) Pay for Performance is a statewide collaboration designed to create the business case for quality at the physician group level. The goal is to reward physician groups for performance in clinical care and patient experience by providing a clear set of health plan expectations, use of common metrics, and public reporting. The performance measures represent a balance of three key areas:

CLINICAL DOMAIN

Measures performance in the management of  the following measures:

IT DOMAIN

Evaluates a physician group's investment in information technology to support clinical quality through the ability to integrate data at the group level or to provide physicians with data to support clinical decision-making at the point of care.

PATIENT SATISFACTION

Evaluates overall performance and is based on individual patient satisfaction in the following areas:

CARDIOVASCULAR MEANINGFUL USE OF HEALTH IT (MUHIT) TIMELY CARE AND SERVICE
DIABETES DOCTOR-PATIENT INTERACTION
MATERNITY CARE COORDINATION
MUSCULOSKELETAL OVERALL RATING OF CARE
PREVENTION OFFICE STAFF
RESPIRATORY HEALTH PROMOTION
RESOURCE USE
50% 30% 20%
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Value Based P4P - 2014

  • P4P is no longer paid on individual performance per measure
  • Historically there was an Improvement in quality but no significant cost savings
  • P4P score will be aggregated and used as the multiplying factor for payout on the following Value Based Measures:
2014 Value Based P4P Measures
ER Visits
Bed Days
Use of Outpatient Surgery Centers
Generics Prescribing
Total Cost of Care

Six participating health plans (representing more than 8 million enrollees) have agreed to participate:

  • Aetna
  • Anthem Blue Cross
  • Blue Shield of California
  • Cigna Health Care of California
  • Health Net
  • United Healthcare

Each plan will use the results on the common performance measures while still designing its own physician group bonus program. The initiative applies only to commercial enrollees and does not apply to Medicare beneficiaries.

For more information, visit: www.iha.org