BWPO is participating in the PCHI HPHC risk contract, where a withhold is taken on physician and hospital fees, to be returned based on specific objectives related to utilization and quality. In 2001, all BWPO withhold dollars were returned to providers, based on BWPO performance. Data for 2002 is still accumulating but preliminary reports indicate that the BWPO should once again have most or all of the withhold returned.
Negotiations with HPHC for the 2003 and 2004 performance measures are in the final stages. Below is a brief summary of what the 2003 performance goals will most likely be:
As in 2002, the HPHC performance goals are set in cascading order. First, in order to be eligible for any withhold to be returned, the PCHI Network patients’ inpatient days per thousand and generic prescribing rate must not deteriorate when compared to year 2000 baseline levels. If there is no deterioration, then the PCHI Network is eligible for withhold return based on several criteria summarized below. If the Network achieves its target, then there are internal PCHI targets that govern the internal funds flow to the BWPO, as reviewed regularly with the BWPO Contracts Committee.
Specific Network Targets for 2003, 2004:
• Reduction in inpatient days.
PCHI and HPHC are analyzing health status adjusted data to set an appropriate days/1000 reduction goal; likely objective will be a reduction of 2.5 percent each year for 2003 and 2004.
• RX Prescribing
In 2003 and 2004 the PCHI Network must exceed the non-PCHI HPHC Network’s generic prescribing rates by one percent.
• Adult Quality Measures
The PCHI Network must reach the 2002 90th percentile screening rates for the four HEDIS diabetes screening measures: hgbA1c, LDL, Eye Exam, Nephropathy; BWPO is already quite close, or exceeding, these targets in 2002.
• Pediatric Quality
PCHI is finalizing the details of a goal tied to chlamydia screening for female HPHC members age 16-20 who have a PCHI pediatrician as their PCP.
• Patient Safety
There will be a patient safety performance measure but PCHI and HPHC have not agreed to the specific target; it may be related to frequency of INR screening for patients on coumadin.
BWPO will keep its members updated as these negotiations proceed and performance data becomes available.