Medica 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.

Starting in 2011, Medica will continue its Choice Care Quality Improvement (CCQI) program while discontinuing its Performance-Based Incentives (PBI) program. As of 2011 dates of service, providers with a provider agreement that includes individual provider quality and/or pay-for-performance metrics will no longer be eligible for any Medica Pay for Performance program incentives.

The following features apply to Medica Pay for Performance programs:

• 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: 2012 program measurements are completed in 2012 and based on 2011 dates of service)
• 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 their MN Community Measurement group identification, 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 following tables outline unique details of each program by its year.

2013 Program Measures 
Choice Care Quality Improvement program

2012 Program Measures
Choice Care Quality Improvement program