2018 INCENTIVE PROGRAM

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Bertram Cummings
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1 2018 INCENTIVE PROGRAM The 2018 Incentive Program for Mesa County Physician IPA (MCPIPA) is a crucial piece of our Clinically Integrated Network. Participation in the Incentive Program is necessary for IPA members to contract through our Clinically Integrated Network. The active involvement of all IPA Member Physicians in the whole Incentive Program is essential as MCPIPA contracts rely less on financial integration and more on clinical integration. The 2018 MCPIPA Incentive Program is accessible and relevant to every specialty. The ongoing Incentive Program is designed to actively evaluate and modify the practice patterns of providers, to create a high degree of interdependence and collaboration, to help control costs, and, to ensure the quality of care provided to patients. There are three components to the Incentive Program: Quality Health Network (QHN) A fixed amount of $61,500 per quarter of the Incentive Pool will be paid to QHN to pay IPA physician monthly dues. The agreement with QHN will not exceed $246,000 for twelve consecutive months. The MCPIPA Board of Directors will continue to approve each installment prior to the payment to Quality Health Network on a quarterly basis. Reward for Participation (R4P) A fixed amount of $75,000 of the Incentive Pool is allocated to fund the Quarterly R4P All Physician meetings. This includes covering costs associated with each meeting and compensation paid to IPA Member Physicians for their attendance. Any remaining funds will be used in the Incentive Measures compensation. Incentive Measures After funding QHN and the R4P meetings, the remaining dollars from the Incentive Pool are allocated and paid to those physicians who meet the requirements of the incentive measures. For 2018 two measures must be met to qualify for the incentive dollars. 1

2 Funding The Incentive Program is funded in its entirety by IPA Member Physicians via a withhold from claims submitted for medical services provided to Rocky Mountain Health Plans (RMHP) Medicare, Commercial and CHP+ patients. Eight percent (8%) of the PAID amount of the claim is withheld and placed into the Incentive Pool. RMHP pays the withheld amount to MCPIPA on a quarterly basis. Disclaimer - Incentives are paid as indicated in the criteria described in this document and as determined by the Incentive Design and Development Committee (IDDC) in cooperation with the MCPIPA Executive Committee and the Board of Directors. The IDDC will determine the Incentive Program guidelines and the application of the guidelines to the particular situations. The IDDC, with approval of the MCPIPA Board of Directors, may make adjustments they deem necessary to reach the goals and objectives of the Incentive Program. The terms of the Program, can be changed or discontinued at the discretion of the MCPIPA Board of Directors. 2

3 INCENTIVE PROGRAM COMPONENTS R4P ALL PHYSICIAN MEETINGS The R4P meetings are held quarterly at a local venue such as Two Rivers Convention Center or similar location. An agenda including discussion topics and meeting details will be sent to IPA member physicians in advance of each meeting. Meeting times: 5:30 6:00 Registration and Dinner 6:00 8:00 General Session which may include IPA business updates, breakout sessions and speakers 2018 Schedule: 1Q2018 R4P Quarterly Meeting Tuesday February 13, Q2018 R4P Quarterly Meeting Tuesday May 22, Q2018 R4P Quarterly Meeting Tuesday August 14, Q2018 R4P Quarterly Meeting Tuesday November 13, 2018 Agenda Topics: We value your input and hope you will share ideas for discussion topics for the Quarterly R4P All Physician Meetings. The topic at each quarterly meeting may be a new subject or a further development of a prior topic if warranted based on interest expressed by the physicians. Please contact the IPA with your suggestions. Budget and Meeting Compensation The R4P budget is funded by allocating $75,000 of the total Incentive Pool each quarter. Under the R4P Program, MCPIPA member physicians will only be compensated for their attendance or presentation at the quarterly meeting. Attendance Compensation: MCPIPA member physicians who attend the R4P quarterly meetings will receive a flat rate of $350 per meeting. Policies and procedures for attendance have been developed by the IPA. Presenter Compensation: MCPIPA member physicians who present a topic and lead the discussion will be compensated at the flat rate of $500. Physicians who are compensated as a Presenter will only receive the Presenter Compensation and they will not receive the Attendance Compensation. 3

4 INCENTIVE MEASURES The MCPIPA Incentive Design and Development Committee, composed of IPA member physicians from both primary and specialty care, worked with the IPA Executive Director and Clinical Program Coordinator to design the 2018 Incentive Program. Once the Incentive Measures were identified and developed, they were vetted through the Executive Committee and approved by the MCPIPA Board of Directors. The IPA Board, the Executive Committee and the Incentive Design and Development Committee are comprised entirely of IPA member physicians. IPA Member Physicians must complete the required Incentive Measures each quarter to be eligible to receive Incentive payments for the completed Measures. IPA Member Physicians who meet the requirements of the Measures will receive the pre-determined value amount stipulated in the written detail of the Measure. For example, the Quality Measure is valued at 75% and, if the physician meets the requirements of this measure, he will receive 75% of his contribution to the Incentive Fund. Distribution of Incentive Funds IPA Member Physicians who complete the required Incentive Measures will be eligible to receive the Incentive Pool distributions for that measure. Conversely, physicians who do not complete the required Measures will not be eligible to receive the compensation for that Incentive Measures. The Incentive Measure payments will be distributed quarterly to those who meet the required benchmarks for each quarter. The amount each physician contributes to the Incentive Pool varies widely because it is eight percent (8%) of the physician s Paid Amount which is the amount paid to the physician by the health plan after patient responsibility is deducted. Effectiveness of the Incentive Measures This wide variability in the amount available for the physician to earn could impact the effectiveness of the general Incentive Measures. Because the individual physician contributions to the Incentive Pool vary each quarter that would mean that the earned value of the incentives measures also vary. For example: Physician A contributed $51.00 to the Incentive Pool. The Technology Measure is weighted at 10%, resulting in a payment to Physician A of $5.10 if the measure is met. The two Quality Measures, each weighted at 45%, would pay $22.95 per measure, if the measures are met. Physician B contributed $7, to the Incentive Pool. The Technology Measure, is weighted at 10%, resulting in a payment to Physician B of $ if the measure is met. The two Quality Measures, each weighted at 45%, would pay $3, per measure, if the measures are met. In November 2016, the IPA general membership approved the creation of a $500 Minimum Threshold to more effectively incentivize all IPA members to participate in our incentive program. Distribution of Incentive Funds using this new methodology was effective with the distribution of the 1Q2017 Incentive Program. The methodology used is a Modified Net Pro-Rated Basis which allows for those physicians whose contribution to the Incentive Pool is less than $500 to be brought up to a minimum threshold of $500 before the payment of the quarterly incentive distribution is calculated. 4

5 Funding of the $500 Minimum Threshold The funding of the $500 Minimum Threshold will come from different sources: 1. Funds from Non-IPA Physicians. The first source of funding for the $500 Minimum Threshold is from physicians who are not members of MCPIPA. Each quarter when Rocky Mountain Health Plans collects the data and calculates the amount to be paid to MCPIPA for the 8% Incentive Plan Fund, the amount received includes dollars from physicians who are NOT members of MCPIPA. Typically these physicians are those who provide coverage for MCPIPA member physicians. Though we have tried, it is too administratively burdensome for RMHP to reconfigure this allocation to MCPIPA. The dollars from Non-IPA physicians varies each quarter. 2. R4P Meeting Attendance. Another source of funding for the $500 Minimum Threshold is from the R4P allotment. Payment for attendance at the Quarterly R4P All Physician meetings will be capped at a flat rate of $350 per meeting per physician. Previously the R4P meeting attendance compensation was calculated by subtracting the cost of the facility, food, presentations (when done) and supplies from the $75,000 budget. The remaining balance was then shared equally with those physicians who attended the meeting. The $500 Minimum Threshold also subtracts the cost of the facility, food, presentations (when done) and supplies from the $75,000. Physicians who attend the Quarterly R4P meetings will receive a flat rate of $350 per meeting and the remaining balance will be used to help fund the $500 Minimum Threshold. If needed, an optional source of funding for the $500 Minimum Threshold is the Bonus Pool. Bonus Pool. The Bonus Pool is funded by those physicians who do not participate in or meet the incentive measures. Historically, this amount of dollars is shared on a pro-rated basis with those physicians who meet the incentive measures. In the event that the funds from Non-IPA Physicians and the change in R4P Meeting Attendance do not provide enough dollars to fund the $500 Minimum Threshold any additional monies needed would come from the Bonus Pool. The remaining funds in the Bonus Pool will be shared on a pro-rated basis with those physicians who met the incentive measures. Conversely, any overage from the Non-IPA Physicians and the funds available through the R4P Meeting Attendance will be included in the Bonus Pool and shared, on a pro-rated basis, with those physicians who met the incentive measures. Other Parameters for the $500 Minimum Threshold: In no event would the threshold be allowed to use more than 10% of the General Incentive Fund. The $500 threshold is the total amount paid, and it is only paid when the member meets the measures and would otherwise receive less than $500/quarter. The amount already contributed by the physician to the General Incentive Fund would be included in the $500 threshold and not in addition to it. For example, if a physician earned $53.00 for the quarter and if they meet the measures they would earn $500.00, and not $ The Incentive Design and Development Committee with direction from the Executive Committee and the Board of Directors, will oversee the distributions and make decisions on the details as needed. 5

6 2018 MCPIPA INCENTIVE MEASURES Must Be Completed at Practice Level ADMINISTRATIVE MEASURE TECHNOLOGY Goal: To maximize the utilization of technology across the Medical Neighborhood: By supporting Safe Opioid Prescribing with: o The sharing of Pain Contracts via Quality Health Network, and; o Utilizing the Prescription Drug Monitoring Program as part of Safe Opioid Prescribing practices. Continue to standardize the Referral Process within the practice by supporting efficient, high quality transitions of care. Outcome Measure: Utilize the Health Information Exchange to share Pain Contracts across the Clinically Integrated Network. Improve communication across the Medical Neighborhood by increasing the use of the Subscription functionality within Quality Health Network. Improve utilization of the Prescription Drug Monitoring Program. Implement performance improvement program focusing on medical neighborhood referral protocols. Includes: All Primary Care and Specialty Practices Value: 25% of total Benchmarks BENCHMARKS 1Q2018: Note: there are TWO REQUIREMENTS for this quarter 1. Practice attends education on QHN Subscription and Uploading/Searching Pain Contracts. o Dates and Locations. Due to Limited space, please RSVP in advance of meeting to info@mcpipa.org or Wednesday February 7, :30 1:00 Quality Health Network office, 744 Horizon Court, Suite 210. Lunch will be provided. Wednesday February 21, 2018 Noon 1:00 Webinar Must register online in advance for the webinar; an for registration will be sent to all Practice Mangers in advance of the event. Wednesday March 7, :30 1:00 Quality Health Network office, 744 Horizon Court, Suite 210. Lunch will be provided. 2. Practice performs internal audit to determine if referral process is being followed. A random audit of five (5) referrals sent from primary care practices or received in specialty practices will be performed internally at the practice. Required referral elements will be assessed. Submit attached Questionnaire to MCPIPA by April 30,

7 2Q2018: Note: there are TWO REQUIREMENTS for this quarter 1. Practices attest that each physician has enrolled in the Prescription Drug Monitoring Program (PDMP) and has a current active User ID and password. 2. Practice level review of audit results of referral process to include physician input. Submit copy of meeting minutes with Questionnaire found in Forms section of this document. Submit attached Questionnaire to MCPIPA by July 31, Q2018: 1. Practice performs PDSA cycle on referral process Submit attached Questionnaire to MCPIPA by October 31, Q2018: Note: there are TWO REQUIREMENTS for this quarter 1. Practice performs second audit of referrals to determine success of process improvement 2. Practice submits policy on use of QHN services. Must include: Pain Contract upload/retrieval Subscription Submit the PDSA form and P & P Questionnaire to MCPIPA by January 31,

8 Must Be Completed by All Physicians GOAL: To educate member physicians on: QUALITY MEASURE SAFE OPIOID PRESCRIBING The CDC recommendations for Safe Opioid Prescribing And Monitoring, The Colorado Consortium for Prescription Drug Abuse Prevention, and The Colorado Department of Health Care Policy and Finance Department policy changes on prescribing and dispensing opioid pain medication. And to: o Incorporate these recommendations and guidelines into Standard Opioid Best Practices across the MCPIPA Clinically Integrated Network o Assess improvement in Safe Opioid Prescribing by member physicians through ongoing analysis of data elements pertaining to safe prescribing and monitoring of prescription opioid prescribing. Outcome Measure: Education to MCPIPA Member Physicians on CDC Guidelines for Safe Opioid Prescribing; the Colorado Consortium for Prescription Drug Abuse Prevention; and, the Colorado Department of Health Care Policy and Finance policy changes on prescribing opioid pain medication. Increased utilization of the Prescription Drug Monitoring Program (PDMP). Identification of community wide challenges regarding Safe Opioid Prescribing. Collaborative discussion to identify community-wide best practices surrounding safe opioid prescribing. Development of practice level policies on Safe Opioid Prescribing based on CDC guidelines and Colorado Department of Health Care Policy and Finance requirements. Includes: All IPA Member Physicians Value: 75% of total Benchmarks 1Q2018: 1. Physician attends general education session on The Opioid Crisis (Part One). Physicians will receive physician level data on prescribing habits and the state of Colorado Medicaid guidelines. The education sessions qualify for both CME and COPIC points. 2. Dates and Locations. IMPORTANT NOTE; THERE ARE ONLY TWO OPTIONS ON SESSIONS. Please RSVP in advance of meeting to info@mcpipa.org or Meals will be provided. Thursday February 22, 2018 Noon 1:30 PM St. Mary s Medical Center Saccomanno Education Center Rooms 2 and 3. Friday March 2, :45 8:15 AM Community Hospital Legacy Conference Room 8

9 2Q2018: 1. Physician reviews online education about PDMP: Submits attestation to having completed education. Submit attached form to MCPIPA by July 31, Q2018: 1. Physicians attend general education session on The Opioid Crisis Part Two. The education sessions qualify for both CME and COPIC points. 2. Date and Locations. IMPORTANT NOTE; THERE ARE ONLY TWO OPTIONS ON SESSIONS. Please RSVP in advance of meeting to or Monday July 9, 2018 Noon 1:30 pm St Mary s Medical Center Saccomanno Education Center Rooms 1 and 2. Tuesday August 14, :30 8:00 pm 3Q2018 Quarterly R4P Meeting, Two Rivers Convention Center, Grand Junction. In addition to CME and COPIC Points, physicians will receive R4P attendance compensation. Options for specialties that do not prescribe opiates. Please contact the IPA for more detail, e.g., Pathology could provide education on drug testing- quick test vs. other tests Neonatology could have something related to how they work with babies who are born addicted. 4Q2018: 1. Submit Practice Policy and Procedure for Safe Opioid Prescribing. This Policy and Procedure should include, at a minimum detail, on how the practice utilizes the PDMP and the state of Colorado Medicaid guidelines. Submit attached form to MCPIPA by January 31,

Rocky Mountain. Monument Health 2016 INDIVIDUAL & FAMILY PLANS. MK843-A-R08/13/15þ

Rocky Mountain. Monument Health 2016 INDIVIDUAL & FAMILY PLANS. MK843-A-R08/13/15þ Rocky Mountain 2016 INDIVIDUAL & FAMILY PLANS MK843-A-R08/13/15þ Rocky Mountain Rocky Mountain Health Plans is Colorado-based and Colorado-focused. We were founded in Grand Junction more than 40 years