P4P 2005 Measurement Year / 2006 Reporting and Payment Year...
2005 Pay for Performance Results
Results for the Clinical Measures (Table 1), the Patient Experience Measures (Table 2), and the IT Measures (Tables 3a and 3b) are included for Measurement Years
2003-2005.
Public Comment on Proposed Measure Set
This is the proposal for the P4P measurement set which will be finalized after
public comment and resulting revisions
Final Measurement Set
The Final Measurement set is the refinement of the proposed measurement
set by the Steering and Technical Committees after considering public comment.
Clinical Specifications
The clinical quality measures are adapted from the National Committee for Quality Assurance’s (NCQA) Health Plan Employer Data and Information Set (HEDIS®1), the most widely used set of performance measures in the managed care industry. NCQA is a not-for-profit organization committed to assessing, reporting on and improving the quality of care provided by organized delivery systems. P4P also includes an audit review to ensure that results are an accurate reflection of PO performance. The audit review of the clinical measures is based on NCQA’s HEDIS Compliance Audit™ program. NCQA staff worked with P4P participants to incorporate the relevant components of the HEDIS Compliance Audit and adapt policies and procedures where necessary, and made enhancements to the process based on
each years experience. Because this program is an adaptation it is considered a Pay for Performance Audit Review, not a HEDIS Compliance Audit™. This manual includes the information needed to collect and report the clinical measures for the
reporting year P4P reporting initiative
2006
Testing Measure Specifications
P4P Testing of Misuse of Rescue Inhalers NDC List
P4P Testing of Misuse Rescue Inhalers NDC List
(Excel Version)
Patient Experience Specifications
A detailed set of measures and questions used to evaluate the patient's
experience with a service provider
Information Technology Specifications
A description of the P4P information technology domain process and
measures with a glossary of terms and related data sources and
examples.
Physician Incentive Bonus
The Physician Incentive Bonus allows a physician organization to qualify for an additional 10% on top of its total P4P score for the 3 domains: clinical, patient experience and IT.
This document describes the process to participate, scoring
methodology, provides a glossary of terms and gives related data sources and
examples.
Data Collection and Aggregation Timeline
(Rev July 2006)
A detailed timeline of events and actions to be taken for the collection
of data, data aggregation, and reporting.
Audit Manual
P4P Audit Review Standards for POs are derived from NCQA’s HEDIS Compliance Audit Standards, the foundation on which Certified HEDIS Compliance Auditors assess a health plan’s ability to report HEDIS data accurately and reliably. These standards represent key processes involved in P4P clinical data collection and reporting.
This section includes the standards and assessments that apply to POs that opt to self-report the P4P clinical data and which are a derived subset of the HEDIS Compliance Audit Standards that health plans must meet during HEDIS audits.
HEDIS® is a registered trademark of the National Committee for Quality Assurance
(NCQA).
Appeals
In spite of a thorough validation process, it is possible for mistakes to remain in such a large data set. Each year, a few discrepancies have been found in the final P4P results reports. Therefore, this year IHA created a formal appeals process for both POs and health plans to appeal for changes in the Final Reports.
Appeals Process
P4P Results Appeal Form
If you would like to download a word version of P4P Results Appeal Form, right
click here. (Choose "Save Target As...)
Top Performing Physician Organizations
A List of Top Performing Physician Organizations by
* Top Performing for Clinical Quality
* Top Performing for Patient Experience
* Top Performing for Information Technology
* Top Performing Overall
Transparency Report for Health Plan Payments
Descriptions of and guidelines for the various areas of measure
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