Pay for Quality Program
On behalf of the Ohio State University and its employees and dependents, OSU Health Plan has initiated a Pay for Quality program, a patient-focused effort to measurably improve the health status of the OSU Health Plan members.
The program is designed to take advantage of existing member preventive care health plan benefits by giving physicians and their staffs timely, actionable information about their patients and about preventive care services that have been completed or could be completed in 2011.
How the Program Will Work
For the initial phase of the program, seven well-recognized preventive health-related measures are included:
- cervical cancer screening
- mammography screening
- colorectal cancer screening
- diabetes care (HbA1c testing, lipid testing, nephropathy measure)
- preventive health visit
All adult primary care physicians (including OB-GYN) in the OSU Health Plan network in Franklin County will receive a list of patients with the corresponding services they need for 2011 or have had in the recent past (for multi-year measures). A progress report will be sent in September with updated information. (Claims data is used for the reports.) A final report with any bonus payments earned will be sent in May 2012 to allow for three full months of claims to be processed for services delivered through Dec. 31, 2011 to maximize credit.
Bonus Program
Bonus payments are available with this program in addition to the normal fee schedule payments. Bonuses will be calculated by measuring the proportion of your patients who receive the eligible service(s) by the end of the calendar year. If the percentage exceeds the baseline measure for the entire OSU Health Plan population, then you will be paid a bonus for each treated patient. For example, if a baseline for screening mammography is 70% and 75% of the eligible members on your list receive the service, a bonus will be paid to you for each of those patients. If the rate is 70% or lower, no bonus will be paid. Additionally, a 90th percentile performance bonus will be available to select physicians who have at least 10 OSU Health Plan members per measure and whose performance exceeds the 90th percentile. Payout of the bonus will be in late May 2012.
For more information about the program, contact Provider Relations representative Aaron Hoops at Aaron.Hoops@osumc.edu or call (614) 292-4700.
Forms and Resources
- Provider Letter
- Frequently Asked Questions - Provides answers to common questions regarding the program.
- Report Sample - A sample of the initial and interim reports you will receive throughout the program.
- Not My Patient Form - Use to correct the patient listing if needed.
- Data Correction Form - Use to update clinical information for patients not needing specific services.