T
he Alliance Care Based
Incentive (CBI) program
will be entering its third
year of implementation on January
1, 2013 (
the second year CBI will
serve as the Alliance’s sole incentive
program—rewarding Primary Care
Physicians for providing quality care).
With gained experience and
valuable feedback from our Primary
Care Providers (PCPs), we have
been able to make improvements
to the program to make it more
meaningful and to enhance the
integrity of the data we collect.
Removing One Measure
The first change is to the breast
cancer screening measure. The
Alliance will track this measure but
not include provider performance
in calculating the incentive. This
change is largely based on a lack
of national consensus about the
different standards that have
been proposed by several national
organizations and study groups (see
the table below).
1.
For women with no symptoms and an average risk. 2. American College of Obstetricians and Gynecologists 3. American College of Physicians 4. Kaiser Permanente Care Management
Institute 5. U.S. Preventive Services Task Force 6. Health Effectiveness Data Information Set (National Committee on Quality Assurance) 7. National Cancer Institute; National Institutes of
Health
AGE
FREQUENCY
ACOG
2
40
to 75 and perhaps beyond
Offer annually
ACP
3
40
to 49: assess risk, patient preference; routine >50
Every 1 to 2 years
KPCMI
4
50
to 75; >75 patient preference
Every 1 to 2 years
USPSTF
5
40
to 49 based on risk, patient preference;
50
to 75 OK; >75 insufficient evidence to judge
2
years
HEDIS
6
42
to 59: two-year look back
2
years
NCI
7
≥40
1
to 2 years
Comparison of Mammography Recommendations by Expert Panels
1
Given the importance of
mammography as a means for early
detection and initiation of treatment,
the Alliance opted to continue
tracking this screening for the health
of our members. However, given the
uncertainty regarding the age range
for women needing these studies and
the interval appropriate for screening,
we will not include mammography
as a measure for CBI in 2013.
Adding a New Measure
The second change is a new
measure, rate of readmission, which
we will also track but not score for
2013.
This measure parallels the
new policy from the Centers for
Medicare & Medicaid Services
(
CMS), which, as of Oct. 1, 2012,
will penalize hospitals with excessive
rates of readmission at 30 days or
less after discharge.
The Alliance will look at 90-day
readmissions, as the 30-day measure
is based on an arbitrary time period
and 90 days might provide a greater
opportunity for the PCP to have an
impact on the patient’s clinical course.
Improving Communication
With two years of experience
operatingCBI, we are now looking to
improve how we communicate with
our PCPs about their performance.
Our fall CBI workshops focused
on the data available to providers
regarding their performance in
the program, and how to use that
data. Staff continue to work toward
providing timely and useful data
through quarterly reports and the
Provider Portal.
One activity that will have a
potential impact is the availability
of patient-specific data for your
practice on the Alliance Provider
Portal. As this develops we will be
communicating with you about how
to access the Provider Portal and what
you will find when you get there.
No Changes
to Member CBI
Finally, you will recall that Alliance
members also participate in CBI,
with measures that parallel those of
the physician CBI. There will be no
significant changes to the member
component of CBI for 2013.
CBI for 2013:
Some Old and
Some New
DECEMBER 2012
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