Medica’s Pay for Performance programs are designed to assess the efficiency and quality related to focused areas of clinical care provided to Medica members by practitioners in the Medica provider network. These programs are also intended to provide financial rewards to those providers driving care improvements and achieving evidence-based outcomes. These programs were created based on provider feedback about costs of improving care and employer/state concerns about healthcare costs, and topics are chosen to better align with other quality improvement efforts taking place in the community. Programs included are the Performance-Based Incentives (PBI) program and the Choice Care Quality Improvement (CCQI) program.
Both programs have the following in common:
- Program payout each year is determined by two factors: provider clinical results and the financial performance of applicable Medica products
- Current program year measurements relate to the previous year (Example: 2009 program measurements are completed in 2010 and based on 2009 dates of service)
- Program communication and report format
- Program reporting and payout occurs in approximately the fourth quarter of each measurement year (based on previous year’s dates of service) or first quarter of the following year
- Groups are identified by federal tax ID and/or contracted groups with multiple federal tax ID numbers, depending on the group and measure
Further criteria for eligibility are defined by each measure.
The tables and descriptions that follow differentiate some of the unique details of each program.
View the Medica Pay for Performance Cycle Overview.
2009 Program Measures
Performance-Based Incentives
Choice Care Quality Improvement program
2008 Program Measures
Performance-Based Incentives
Choice Care Quality Improvement program
2007 Program Measures
Performance-Based Incentives
Choice Care Quality Improvement program
2006 Program Measures
Performance-Based Incentives
Choice Care Quality Improvement program
2005 Program Measures
Performance-Based Incentives
Choice Care Quality Improvement program