The document describes several healthcare organizations' Performance Recognition Programs (PRP) for 2013. It outlines changes made to the programs, including increasing budgets, eliminating pay-as-you-go components, and scoring providers individually on quality measures. Providers can earn payments by meeting quality goals or improving scores by a certain percentage. The programs include measures related to preventative screenings, disease management, and controlling conditions like diabetes and cardiovascular disease. Bonus payments are available for measures like adult BMI tracking and annual medication monitoring.
By 2015, group physician practices of 10 or more eligible Medicare providers will be required by the Centers for Medicare and Medicaid Services to participate in the value-based modifier program. Is your practice prepared to participate? This Quirk Healthcare Solutions Insights webinar provides a solid overview of the impending rollout.
By 2015, group physician practices of 10 or more eligible Medicare providers will be required by the Centers for Medicare and Medicaid Services to participate in the value-based modifier program. Is your practice prepared to participate? This Quirk Healthcare Solutions Insights webinar provides a solid overview of the impending rollout.
The Surprising ROI of Employee WellnessMedgate Inc.
If you see wellness programs as a nice-to-have, but not core to your employee health programs, you could be missing an opportunity to greatly improve your company’s bottom line. If you structure the program properly, show commitment, and promote it well, you could make huge cost savings while improving the overall health of your employees and their families.
In this case study webinar, Johnny White, Benefits, Medical and Wellness Leader at Logan Aluminum, will showcase the striking successes of its wellness program, which has been in place for over 20 years.
At Logan, the wellness data is so rich that their healthcare benefits provider has renewed at less the half the national average increase for thirteen years running. Logan’s employees make no contribution towards this coverage. That Logan is able to make these huge compound savings in a state that consistently ranks in the bottom ten for public health indicators makes it all the more remarkable.
The CMS Innovation Center held a Medicare Diabetes Prevention Program webinar on August 9, 2016 from 12:00 – 1:00p.m. EDT. This webinar provided an overview of the proposal in calendar year 2017 Medicare Physician Fee Schedule.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Accountable Care Organization Final Rule may be a 700-page mammoth, but fear not! This presentation will provide you with the highlights you need to know about the Final Rule, including details on the ACO contract with CMS; information on ACOs and FQHCs, Rural Health Centers and Hospitals; required processes and patient-centered criteria; quality and reporting highlights; application details; and more!
This presentation is supplemental material to RadioRev episode 1: Understanding Medicare Star Ratings with Sara Ratner. We cover everything from the nuts and bolts of Medicare Star Ratings, what they are, why they matter, and who should care about them. Plus, we look to the future and learn everything you need to know for what's on the horizon in 2019.
Healthy Advantage Rewards is a new wellness product offered to employers through Security Health Plan. Visit www.securityhealth.org/healthyrewards for more information.
Making CJR Work for You: A Roadmap for Successful Implementation of Medicare ...Wellbe
This presentation will describe a structured approach to successfully launching a program for the Comprehensive Care for Joint Replacement (CJR) Model. Based on years of experience with bundled programs, this roadmap provides the basis for developing a targeted plan for your organization as the April 1, 2016 deadline for CJR rapidly approaches.
Key topics to be addressed include:
• Overview of CJR rules and program requirements
• CJR implications for your organization
• Bundle evaluation – financial and clinical issues
• Gainsharing considerations with program collaborators
• Designing an effective post-acute care network
• Using analytics to develop and monitor your program
• Key “must-dos” for an April 1, 2016 launch
Learning Objectives:
1. Describe the rules and requirements of CJR
2. Assess the key success drivers in bundle performance
3. Evaluate where and why organizations fail in bundles
4. Develop strategies and tactics to create a post-acute partnership
5. Illustrate risk stratification factors in bundle design
About the Speaker:
Sheldon Hamburger is an Alternative Payment Model advisor for hospitals and healthcare firms nationally. With a focus on program implementation, he brings extensive knowledge and experience gained from more than 25 years of healthcare financial consulting, technology design and development, and sales & marketing strategy for Fortune 1000 clients. He is a frequently sought-after speaker and writer on regulatory and technology trends affecting hospital operations, provider reimbursement issues, BPCI / CJR, programs and regulations, medical expense strategies and payer-provider dynamics. Residing in Raleigh, he is an active member of HIMSS, HFMA, & ACHE. He earned his B.S.E. in Computer Engineering from the University of Michigan.
Better care at less cost - a 'how to' for commissioners and providers, pop up...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Quality and Outcome Framework (QOF) is a voluntary annual incentive programme for GPs in England, detailing practice achievement results. The primary objective of QOF is to drive the quality of primary care and reduce variations in the quality of care amongst GPs
The Surprising ROI of Employee WellnessMedgate Inc.
If you see wellness programs as a nice-to-have, but not core to your employee health programs, you could be missing an opportunity to greatly improve your company’s bottom line. If you structure the program properly, show commitment, and promote it well, you could make huge cost savings while improving the overall health of your employees and their families.
In this case study webinar, Johnny White, Benefits, Medical and Wellness Leader at Logan Aluminum, will showcase the striking successes of its wellness program, which has been in place for over 20 years.
At Logan, the wellness data is so rich that their healthcare benefits provider has renewed at less the half the national average increase for thirteen years running. Logan’s employees make no contribution towards this coverage. That Logan is able to make these huge compound savings in a state that consistently ranks in the bottom ten for public health indicators makes it all the more remarkable.
The CMS Innovation Center held a Medicare Diabetes Prevention Program webinar on August 9, 2016 from 12:00 – 1:00p.m. EDT. This webinar provided an overview of the proposal in calendar year 2017 Medicare Physician Fee Schedule.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Accountable Care Organization Final Rule may be a 700-page mammoth, but fear not! This presentation will provide you with the highlights you need to know about the Final Rule, including details on the ACO contract with CMS; information on ACOs and FQHCs, Rural Health Centers and Hospitals; required processes and patient-centered criteria; quality and reporting highlights; application details; and more!
This presentation is supplemental material to RadioRev episode 1: Understanding Medicare Star Ratings with Sara Ratner. We cover everything from the nuts and bolts of Medicare Star Ratings, what they are, why they matter, and who should care about them. Plus, we look to the future and learn everything you need to know for what's on the horizon in 2019.
Healthy Advantage Rewards is a new wellness product offered to employers through Security Health Plan. Visit www.securityhealth.org/healthyrewards for more information.
Making CJR Work for You: A Roadmap for Successful Implementation of Medicare ...Wellbe
This presentation will describe a structured approach to successfully launching a program for the Comprehensive Care for Joint Replacement (CJR) Model. Based on years of experience with bundled programs, this roadmap provides the basis for developing a targeted plan for your organization as the April 1, 2016 deadline for CJR rapidly approaches.
Key topics to be addressed include:
• Overview of CJR rules and program requirements
• CJR implications for your organization
• Bundle evaluation – financial and clinical issues
• Gainsharing considerations with program collaborators
• Designing an effective post-acute care network
• Using analytics to develop and monitor your program
• Key “must-dos” for an April 1, 2016 launch
Learning Objectives:
1. Describe the rules and requirements of CJR
2. Assess the key success drivers in bundle performance
3. Evaluate where and why organizations fail in bundles
4. Develop strategies and tactics to create a post-acute partnership
5. Illustrate risk stratification factors in bundle design
About the Speaker:
Sheldon Hamburger is an Alternative Payment Model advisor for hospitals and healthcare firms nationally. With a focus on program implementation, he brings extensive knowledge and experience gained from more than 25 years of healthcare financial consulting, technology design and development, and sales & marketing strategy for Fortune 1000 clients. He is a frequently sought-after speaker and writer on regulatory and technology trends affecting hospital operations, provider reimbursement issues, BPCI / CJR, programs and regulations, medical expense strategies and payer-provider dynamics. Residing in Raleigh, he is an active member of HIMSS, HFMA, & ACHE. He earned his B.S.E. in Computer Engineering from the University of Michigan.
Better care at less cost - a 'how to' for commissioners and providers, pop up...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Quality and Outcome Framework (QOF) is a voluntary annual incentive programme for GPs in England, detailing practice achievement results. The primary objective of QOF is to drive the quality of primary care and reduce variations in the quality of care amongst GPs
Health care providers today face an overwhelming number of change initiatives that aim to move the provider community in a given direction by leveraging incentives and penalties. Learn about all of the incentives and penalties CMS is leveraging to drive health care reform.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. Blue Care Network HMOSM
(commercial)
2013 Performance
Recognition Program (PRP)
2
3. BCN HMO 2013 PRP:
Overview
• Blue Care Network has redesigned the 2013
commercial PRP program, based on industry-wide
research conducted on plans across the country
that performed well on HEDIS®
* metrics.
• The changes to the 2013 recognition program are
focused on outcome-based scores that will directly
align with HEDIS results.
3
* HEDIS®
is a registered trademark of the National Committee for Quality Assurance.
4. BCN HMO 2013 PRP:
Summary of changes
• The budget has been increased.
• The pay-as-you-go component was eliminated.
• An improvement on the Base PRP component is
being introduced:
Providers who do not meet the BCN plan goal rate
for a measure are eligible for a payment if they
have improved their quality score by 5 percent or
more from their 2012 final Base PRP score.
4
5. BCN HMO 2013 PRP:
Summary of changes
(continued)
• The Base PRP will be scored and paid on each
individual quality measure instead of an overall
threshold score.
The score for each measure will fall into one of the
following categories:
– Met Base PRP – Provider achieved the BCN plan goal
rate.
– Met improvement on Base PRP – Provider did not
meet the plan goal rate but improve on the Base PRP
by the percentage needed.
– Not met – Provider did not meet the plan goal rate or
improve on the Base PRP by the percentage needed.
5
6. BCN HMO 2013 PRP:
Summary of changes
(continued)
• BCN plan goal rate will need to be met in order to earn
the Base PRP per-service-dollar amount.
• Providers who don’t meet plan goal rate may qualify
for the Improvement on Base PRP component.
• All Base PRP and Improvement on Base PRP
components will be scored and paid at a practice
group level.
Note: Providers who do not submit claims under a
practice group will be scored and paid at their
individual practitioner level.
6
7. BCN HMO 2013 PRP:
Base and Bonus
measures
7
2013 Base PRP measures:
Quality – Preventive Screening
Well child – 15 months
Childhood immunizations – Combo 2
Cervical cancer screening
Breast cancer screening
Colorectal cancer screening
Quality – Disease Management
Diabetes retinal eye exam
Diabetes A1C testing
Diabetes A1C control ≤9%
Diabetes LDL-C testing
Diabetes LDL-C control <100 mg/dL
Cardiovascular disease LDL-C testing
Cardiovascular disease LDL-C control <100 mg/dL
Quality Payout – two opportunities:
Payment by measure for meeting plan goal
OR
Payment by measure for improvement of 5% or more
2013 PRP Bonus Incentives
Commercial HMO
• Appropriate testing for children with pharyngitis
Measurement time frame Jan. 1, 2013 – Nov. 30, 2013
$75 per eligible member per service
• Appropriate treatment for children with upper respiratory
infection
Measurement time frame Jan.1, 2013 – Dec.31, 2013
$75 per eligible member per service
• Avoidance of antibiotic treatment in adults with acute
bronchitis
Measurement time frame Jan.1, 2013 – Dec. 24, 2013
$75 per eligible member per service
• Follow up care for children with ADHD – initiation phase
Jan. 1, 2013 – Dec. 31, 2013
$75 per eligible member per service
• Chlamydia screening
Measurement time frame Jan. 1, 2013 - Dec.31, 2013
$40 per eligible member per service
NOTE: Please visit the home page on Health e-BlueSM
for a complete description and
for other information regarding the 2013 Performance Recognition Program.
8. BCN HMO 2013 PRP:
Base PRP payment
chart
8
Base PRP
Base PRP Incentive Measures
2013
Plan Goal
Rate
$Amount
Per Service
Practice group or individual provider achieved the plan
goal rate, the payment is:
Breast cancer screening 80% $50 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Cardiovascular LDL-C control <100
mg/dL 70% $100 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Cardiovascular LDL-C testing 92% $40 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Cervical cancer screening 84% $50 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Childhood immunization - combo 2 89% $250 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Colorectal cancer screening 72% $50 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Diabetes care - A1C control ≤9% 81% $100 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Diabetes care - A1C testing 93% $40 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Diabetes care - LDL-C control <100
mg/dL 49% $100 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Diabetes care - LDL-C testing 89% $40 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Diabetes care - retinal eye exam 74% $100 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Well child visits 15 months 84% $150 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
9. BCN HMO 2013 PRP:
Improvement on Base PRP
payment chart
9
Improvement on Base PRP
Base PRP Incentive Measures
Percentage
Improved
$Amount
Per Service
Practice group or individual provider did not meet plan
goal rate, but improved from prior year by the
appropriate percentage needed, the payment is:
Breast cancer screening 5% $30 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Cardiovascular LDL-C control <100
mg/dL 5% $40 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Cardiovascular LDL-C testing 5% $25 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Cervical cancer screening 5% $30 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Childhood immunization - combo 2 5% $150 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Colorectal cancer screening 5% $30 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Diabetes care - A1C control ≤9% 5% $40 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Diabetes care - A1C testing 5% $25 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Diabetes care - LDL-C control <100
mg/dL 5% $40 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Diabetes care - LDL-C testing 5% $25 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Diabetes care - retinal eye exam 5% $50 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
Well child visits 15 months 5% $75 ($Amount Per Service) x (Elig Mbrs Meeting Criteria)
10. BCN HMO 2013 PRP:
Practice group scorecard
example
10
EXAMPLE 2013 Commercial PRP Scorecard
Practice group: Internal medical group
Base PRP Measures
Total
Mbrs Elig
Elig Mbrs
Meeting
Criteria
2013 Base
PRP Score
2013 Plan
Goal Rate
2012 Final
Base PRP
score % improved Payment Type
$/Service
met
Payment
Earned
Well Child visit 0 -15 months 5 4 80% 84% 85% -5.9% Not met $0 $0
Childhood Imms Combo 2 3 2 67% 89% 62% 7.5% Met improvement $150 $300
Cervical Cancer Screening 16 14 88% 84% 80% 9.4% Met Base PRP $50 $700
Breast Cancer Screening 15 10 67% 80% 70% -4.8% Not met $0 $0
Colorectal Cancer Screening 15 10 67% 72% 60% 11.1% Met improvement $30 $300
Diabetes
Eye exam 8 7 88% 74% 60% 45.8% Met Base PRP $100 $700
A1C Testing 8 7 88% 93% 80% 9.4% Met improvement $25 $175
A1C Control ≤ 9% 8 5 63% 81% 55% 13.6% Met improvement $40 $200
LDL-C 8 6 75% 89% 75% 0.0% Not met $0 $0
LDL-C control <100 mg/dl 8 5 63% 49% 50% 25.0% Met Base PRP $100 $500
Cardiovascular disease
LDL-C 10 8 80% 92% 65% 23.1% Met improvement $25 $200
LDL-C control <100 mg/dl 10 7 70% 70% 62% 12.9% Met Base PRP $100 $700
Payment amount $3,775
11. Blues Medicare Advantage
(BCN AdvantageSM
and
BCBSM Medicare Plus Blue PPOSM
)
2013 Performance
Recognition Program
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12. Blues Medicare Advantage 2013 PRP:
Base and Bonus measures
2013 Base PRP Measures:
Quality – Preventive Screening
Breast cancer screening
Colorectal cancer screening
Quality – Disease Management
Diabetes retinal eye exam
Diabetes HbA1C level ≤9%
Diabetes monitoring for nephropathy
Diabetes LDL-C level <100 mg/dL
Diabetes LDL-C testing
Cardiovascular disease LDL-C testing
Quality Payout -
Quality composite score 70-74%: $2.00 PMPM
Quality composite score 75-79%: $3.50 PMPM
Quality composite score ≥80%: $5.00 PMPM
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2013 Bonus Incentives
BCNA/MAPPO
Annual monitoring for patients on persistent
medications
Diabetes treatment (ACE/ARB for hypertension)
Glaucoma testing
High-risk medications
Adult BMI
2013 Pay As You Go Incentives
BCNA/MAPPO
All 8 base PRP measures
Scoring and Payout
Fall 2013 and spring 2014
Payment PAYG $10
13. Blues Medicare Advantage 2013 PRP:
Bonus opportunities
Adult BMI
• Measurement time frame is Jan. 1, 2012 – Dec. 31, 2013.
• Provider must be with BCN at time of payment to earn the
payment.
• Payment will be made at the practice group level.
• Potential reward to be earned = $200
Annual monitoring for patients on persistent medications
• Measurement timeframe is Jan. 1, 2013 – Dec. 31, 2013.
• Provider must be with BCN at time of payment to earn the
payment.
• Payment will be made at the practice group level.
• Potential reward to be earned = $200
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14. Blues Medicare Advantage 2013 PRP:
Bonus opportunities
(continued)
Diabetes treatment (ACE/ARB for hypertension)
• Measurement time frame is Jan. 1, 2013 – Dec. 31, 2013.
• Provider must be with BCN at time of payment to earn the
payment.
• Payment will be made at the practice group level.
• Potential reward to be earned = $200
Glaucoma testing
• Measurement time frame is Jan. 1, 2012 – Dec. 31, 2013.
• Provider must be with BCN at time of payment to earn the
payment.
• Payment will be made at the practice group level.
• Potential reward to be earned = $125 - $300
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15. Blues Medicare Advantage 2013 PRP:
Bonus opportunities
(continued)
High risk medication
• Measurement time frame is Jan. 1, 2013 – Dec. 31, 2013.
• Provider must be with BCN at time of payment to earn the
payment.
• Payment will be made at the practice group level.
• Potential reward to be earned = $450
NOTE: A complete booklet about the Blues Medicare Advantage 2013 Performance Recognition Program
is located on the home pages of BCN’s and BCBSM’s Health e-Blue website.
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16. Blues Medicare Advantage 2013 PRP:
Diagnosis Closure Incentive
plan
Diagnosis Closure Incentive highlights:
• Measured at the individual physician level.
• Primary care physicians with one or more Blues Medicare
Advantage patients with at least one open diagnosis gap
identified by the Blues will receive $100 per patient for closing
100 percent of the patient’s diagnosis code gaps.
• Suspected or historic conditions not accurately documented
and coded in the current year are diagnosis gaps.
• Diagnosis gaps will be identified in the new Diagnosis
Evaluation report on Health e-Blue.
• Gaps identified by the Blues Jan. 1 through Sep. 30, 2013,
are eligible for payment.
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17. Blues Medicare Advantage 2013 PRP:
Diagnosis Closure Incentive
Plan (continued)
To earn payment for a patient:
• All the patient’s gaps must be closed in 2013 and reported to the
Blues by Jan. 31, 2014.
• The gaps must be closed following a face-to-face visit.
• The diagnosed conditions must be addressed at the face-to-face
visit.
• Coding and documentation must follow CDC and CMS
standards.
• Gaps closed by InovalonTM
(vendor) will not count for the provider.
NOTE: Step-by-step instructions are located in the Resources section at the bottom
of the Health e Blue Homepage – Training Materials
Health e-Blue Phase 10.3 Enhancements March 2013
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21. Blue Cross Complete 2013 PRP:
Quality PAYG measures
(continued)
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NOTE: Blue Cross Complete of Michigan 2013 Performance Recognition Program
materials are located on Health e-Blue, in the bottom section on the home page.