A Maternity Care Incentive Plan For Maternity Care .
Maternity Quality Care PlusA Maternity Care Incentive Plan forMaternity Care PractitionersEffective April 1, 2016
Health Partners Plans would like to express our appreciation for the invaluable roleobstetricians, midwives, nurse practitioners and primary care physicians play in improvingbirth outcomes.Our maternity care practitioners represent “partners” in the truest sense of the word,providing quality care that is accessible, effective and efficient.Our Maternity Quality Care Plus incentive program is designed to recognize and rewardyour practice’s quality performance throughout the year. This manual highlights whatyou need to know to understand and maximize your incentive payments.Confidential and proprietary document for discussion ONLY between Health Partners Plansand participating maternity care practitioners.
Table of ContentsHEDIS (Healthcare Effectiveness Data and Information Set) 2016 Measures . 2Timeliness of First Prenatal Visit . 2Frequency of Ongoing Prenatal Care . 2Postpartum Care . 2Future Program Measure: Cesarean Section Rate. 3Payment for Obstetrical Needs Assessment Form (ONAF) Submission. 6Sample Report Card . 8Frequently Asked Questions . 91
Healthcare Effectiveness Data and Information Set(HEDIS) MeasuresTimeliness of First Prenatal VisitPostpartum CareDefined as the percentage of deliveries thatDefined as the percentage of Health Partnersreceived a prenatal care visit as a Health(Medicaid) deliveries that had a postpartumPartners (Medicaid) member in the firstvisit between 21 and 56 days after delivery.trimester or within 42 days of enrollment inFor more information visit: www.ncqa.orgHealth Partners (Medicaid).Frequency of Ongoing Prenatal CareThe percentage of Health Partners (Medicaid)deliveries that completed 81% of expectedprenatal visits as detailed in the chart below:Expected Number of Prenatal Care Visits for a Given Gestational Age andMonth Member Enrolled with Health Partners PlansDeveloped by the National Committee for Quality Assurance (NCQA).Month of Pregnancy Member Enrolled with Health Partners PlansGestationalAge in 1110973431716151412111084Note: Dashes indicate that no visits are expected.2
Future Program Measure:Cesarean Section (C-Section) RateThe Centers for Disease Control and Prevention(CDC) reports a total United States C-sectionrate of 32.7% percent in 2013. The C-sectionrate in Pennsylvania was 31.4% in reans.htm), with the lowest hospital ratereported as 20.7% and 40.3% being the highest.The Health Partners Plans C-section rate hasbeen approximately 30% in recent years.(http://www.acog.org/About ACOG/NewsRoom/News Releases/2014/NationsObGyns Take Aim at Preventing Cesareans)“ACOG has established a goal of 15.5% cesareansfor first time births” and “the World HealthOrganization (WHO) advocates a rate of nomore than 15% of all s/PMC1595104/pdf/JPE110041.pdf)The Pennsylvania Medicaid program penalizesManaged Care Organizations (MCOs) with aC-section rate of 25% or higher. American Collegeof Obstetricians and Gynecologists (ACOG)published new guidelines in February 2014 toprevent C-sections after seeing a 60% increasein C-section delivery from 1996 and 2011 andthe related concern that “cesarean delivery isoverused without clear evidence of improvedmaternal or newborn outcomes.”Health Partners Plans desires to collaboratewith maternity care practitioners to discoveropportunities to reduce the variation in C-sectionrates. The rate for your practice [at the taxidentification number (TIN) level] will beincluded on your monthly report card (seeexample on page 8). Health Partners Plans willadd a measure for appropriate C-sections to thisincentive program for the October 2016 bonuspayout period to encourage a more appropriateC-section rate in the future.3
Monthly Payments by Maternity Care Practice(Tax Identification Number TIN) Percentile ScorePatient activity for all maternity care practitionersHealth Partners (Medicaid) maternity careaffiliated with your Tax Identification Numberpractices and a percentile score comparing your(TIN) is consolidated and reported at thepractice to your peers is calculated for eachpractice level. To qualify for a monthly incentivepractice (at the TIN level). If you score is abovepayment, the practice must have a minimum ofthe 50th percentile for any of the three HEDIS15 patients who were seen at this practice for atmeasures during the twelve-month reportingleast 75% of each patient’s total prenatal visitsperiod, you will receive monthly per patientduring the twelve month reporting period. Also,incentive compensation as detailed in the tablethe practice must be accepting new Healthbelow. (Monthly payment amounts are alsoPartners (Medicaid) obstetric patients. Yourannualized for your information.)practice’s results are compared with otherPercentileMonthly Paymentper patientfor each of 3HEDIS MeasuresMonthly Paymentper patientfor all 3HEDIS MeasuresAnnual Paymentper patientfor each of 3HEDIS MeasuresAnnual Paymentper patientfor all 3HEDIS Measures90th and above 22.08 66.25 265.00 795.00th80 – 89 18.75 56.25 225.00 675.00th70 – 79 15.42 46.25 185.00 555.0060th – 69th 12.08 36.25 145.00 435.0050 – 59 8.75 26.25 105.00 315.000 – 49 0 0 0 0ththth4thth
Monthly Payments Maternity Care Practice(Tax Identification Number TIN) Percentile ScoreExample 1:A practice with 100 Health Partners (Medicaid) patients during the reporting period scoringbetween the 70th and 79th percentile for all three HEDIS measures will receive a monthlypayment in that amount of 4,625 or 55,500 annually (or 555.00 per patient per year).Math: 100 x 46.25 4,625 x 12 55,500.Example 2:A practice with 250 patients scoring in the 90th percentile (250 x 22.08 5,520 monthlyfor Timeliness of Prenatal Care, the 82nd percentile (250 x 18.75 4,687.50 monthly) forFrequency of Prenatal Care and the 45th percentile for Postpartum Care ( 0) will receivea monthly payment in the amount of 10,207.50 ( 5,520 4,687.50). The annualizedpayment is 122,490 ( 10,207.50 x 12 months) or 489.96 per patient per year( 122,207.50/250 patients).Example 3:A practice with 325 patients scoring above the 90th percentile for all three measures willreceive a monthly payment in the amount of 21,531.25 (325 x 66.25). The annualizedpayment is 258,372 ( 21,531 x 12) or 794.99 per patient per year ( 258,372/325 patients).5
Payment for Obstetrical Needs Assessment Form(ONAF) SubmissionHealth Partners Plans relies on your prompt submission of the Obstetrical Needs AssessmentForm (ONAF) to enroll members into our Baby Partners program. We currently use the ONAF toengage the mother and assist with coordination of care in collaboration with the practitioner.Health Partners Plans will continue to provide an incentive in the amount of 100 for each of thethree sections of the ONAF submitted in 2016. The forms must be completed, dated and signedby the practitioner in order to be accepted. Claims must be submitted as noted in the tablebelow in coordination with a faxed copy of ONAF being forwarded to the Baby Partners programat 215-967-4492.Baby Partners ntiveHealth Partners PlansReviewFirstprenatal visitProvider must completeall sections of the ONAFincluding smoking anddepression screeningand tool used. Fax within7 days of the visit.0500F withHD modifierwith date offirst prenatalvisit 100.00Health Partners Plans willreview ONAF form forcompletion and contactthe member to enroll in theBaby Partners program.Ongoingprenatal careProvider must list allof the prenatal appointments that the membercompleted on the ONAF.Submit after the lastprenatal appointmentor with postpartum visitsubmission.0500F withHD modifierwith date oflast prenatalvisit 100.00Health Partners Planswill review to confirm thatvisits were documented.PostpartumvisitProvider must complete“postpartum visit” sectionof the ONAF completelyand include requireddelivery data. The visitmust take place between21-56 days after delivery.0503F withHD modifier 100.00Health Partners Planswill review that thepostpartum section hasbeen fully completedand that the visit is withinthe time frame specified.A retrospective form review will be performed and Health Partners Plans reserves the right toretract payment in part or in full if the forms are not completed and/or submitted as requiredor the postpartum appointment is not within the specified time frame.The ONAF form and instructions are located /documents/form/d 003632.pdf6
Payment for Obstetrical Needs Assessment Form(ONAF) SubmissionBaby Partners Patient IncentivesHealth Partners Plans has developed an incentive program that rewards members who scheduleneeded checkups, while staying in contact with our Baby Partners care coordinators. This initiativeis also designed to improve HEDIS measures in the areas of prenatal and postpartum care anddental screenings for pregnant members.How the patient incentive program worksWe provide Baby Partners participants with a restricted gift card good for purchases at FamilyDollar, Dollar General and Rite Aid. Members can earn up to 100 that can be used to purchaseitems selected to meet the needs of mother and child during pregnancy and beyond. Items mayinclude diapers, lotion, shampoo, milk, medicine, baby toys and more.Upon completion of each of the following doctor visits, gift cards are credited with 25: First Prenatal visit within the first trimester or within 42 days of enrollmentin Health Partners Plans Completion of a dental screening visit (anytime during the pregnancy or upto 60 days post-delivery) Postpartum visit within 21 to 56 days after deliveryMembers who complete all three steps will also receive a 25 bonus, totaling 100. Memberswho are not known to the Baby Partners staff during their pregnancy receive an outreach callafter delivery and still have an opportunity to earn up to 50 for a dental screening andpostpartum visit. Each time the card is loaded, an automated phone message is sent to themember notifying them.Baby Partners staff can be contacted for questions or referrals at 215-967-4690.7
Sample Report Card8
Frequently Asked Questions1. Who is eligible to participate in the Maternity Care Incentive Plan?To qualify for a monthly incentive, the maternity care practice must have at least 15 patientsand all patients must be seen by your practice for at least 75% of each patient’s prenatal visits.Also, the practice must be accepting new Health Partners (Medicaid) maternity patients.2. How is the Maternity Care Incentive Plan payment calculated?Your practice results are compared with other Health Partners (Medicaid) maternity carepractice and a percentile score is calculated for each practice (at the TIN level). If you scoreabove the 50th percentile for any of the three HEDIS measures during the twelve-monthreporting period, you will receive monthly per patient incentive compensation (as detailedin the Table on page 2).3. When will I receive the Maternity Care Incentive payment?A separate incentive check will be issued monthly to your practice (as defined by TaxIdentification Number or TIN) to reward your performance on the program measures.4. How does percentile ranking work?A percentile rank is the percentage of scores that fall at or below a given score. For example,if ABC Obstetrics ranked 14th out of 67 OB groups for the Frequency of Ongoing Prenatal Caremeasure, then 53 other OB groups were ranked below ABC Obstetrics. ABC’s percentile rankwould be calculated as: 53/67 .791 79th percentile.5. Will I receive any reports to track my practice’s incentive compensation?You will receive a report each month with your incentive check. Reports are updated everysix months and describe a twelve-month reporting period. April 2016 checks are calculatedbased on claims and other data submitted by your maternity care practice during the twelvemonths ending December 31, 2015. Reports are updated again in October for the twelve monthreporting period ending June 30, 2016.6. Who should I contact with questions about this program?Contact your Network Account Manager. Their name and contact information appears on thereport that accompanies your monthly incentive check.9
888-991-9023HealthPartnersPlans.comHealth Partners Plans901 Market Street, Suite 500Philadelphia, PA 19107CC-616-15
Our maternity care practitioners represent “partners” in the truest sense of the word, providing quality care that is accessible, effective and efficient. Our Maternity Quality Care Plus incentive program is d
The maternity incentive scheme applies to all acute trusts that deliver maternity services and are members of the CNST. As in year one, members will contribute an additional 10% of the CNST maternity premium to the scheme cre
15 STPS FOR MATITY: QUALITY FROM THE PERSPECTIVE OF PEOPLE WHO USE MATERNITY SERVICES 15 STPS FOR MATITY: QUALITY FROM THE PERSPECTIVE OF PEOPLE WHO USE MATERNITY SERVICES 7 2. GETTING STARTED WITH THE 15 STEPS FOR MATERNITY The Maternity Voices Partnership Service User Chair gathers users/ user representatives, if possible, including partners, family members
The International Childbirth Education Association (ICEA) maintains that family centered maternity care is the foundation on which normal physiologic maternity care resides. Further, family-centered maternity care may be carried out in any birth setting: home, birth center, hos
to go [23, 24], particularly in maternity care [25–28]. There is a limited understanding of the evidence that is (and is not) translated into maternity care, the associated reasons and how population health can be bolstered via evidence-based maternity care [25]. This warrants concern for (at least) three k
NATIONAL GUIDANCE ON COLLABORATIVE MATERNITY CARE Contents NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL v Boxes Box 1.1 Definition of maternity care collaboration 7 Box 1.2 Principles of maternity care collaboration 7 Box 1.3 Terminology used in the Guidance
Maternity Care Bundle & Doula Benefit SUMMARY AND FAQ Overview Starting January 1, 2021, Microsoft members who elect the Health Connect Plan will be eligible for a new maternity care benefit, called the Maternity Bundle. T
2. Group Incentive Plans Team Incentive Plans – Compensation plans where all team members receive an incentive bonus payment when production or service standards are met or exceeded. Establishing Team Incentive Payments – Set performance measures upon which incentive payments are based – Determine the size of the incentive bonus.
1 Advanced Engineering Mathematics C. Ray Wylie, Louis C. Barrett McGraw-Hill Book Co 6th Edition, 1995 2 Introductory Methods of Numerical Analysis S. S. Sastry Prentice Hall of India 4th Edition 2010 3 Higher Engineering Mathematics B.V. Ramana McGraw-Hill 11 th Edition,2010 4 A Text Book of Engineering Mathematics N. P. Bali and Manish Goyal Laxmi Publications 2014 5 Advanced Engineering .
