obstetrical pay for performance. introduction the department of social services is introducing a pay...
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Obstetrical Pay For Performance
Introduction • The Department of Social Services is introducing a Pay for
Performance (P4P) Program in obstetrics care, beginning August 1, 2013.
• The purpose of this program is to improve the care for pregnant women and the outcomes of their newborns covered under the HUSKY Health programs.
• A total of $1.2 million was appropriated by the Connecticut General Assembly to be paid to providers of obstetric care in State Fiscal Year 2015. Obstetrical P4P payments are in addition to current fee for service payments.
Eligible Providers
• Providers eligible to participate in the obstetric P4P Program are providers currently enrolled as family medicine physicians, obstetrician/gynecologists, obstetric nurse practitioners, family medicine nurse practitioners, physician assistants and certified nurse midwives enrolled in the Connecticut Medical Assistance Program (CMAP) network and providing obstetric care to eligible Husky Health and Charter Oak Health Plan clients.
Performance Measures • The following performance measures (with their associated point values)
are those for which the Department will provide incentive payments:Performance Measure Point Value
Timely completion (within 14 days) of online obstetrics prenatal and post-partum notification forms
5
A first obstetric visit within 14 days after confirmation of pregnancy 25
At least one postpartum visit within 21 – 56 days after delivery 25
Full-term, vaginal delivery after spontaneous labor whenever medically possible.
30
Appropriate use of 17-alpha hydroxyprogesterone when there is prior history of singleton preterm labor NOTE: 30 points if used when indicated;
30
NOTE: 30 points subtracted from the provider’s total if NOT used when clinically indicated.
-30
Evaluating Provider Performance
Data on provider’s performance on the above measures will be collected from claims and from the obstetrics notification forms.
Only episodes of care for which providers use the online obstetrics notification forms will be eligible for the P4P Program.
Data CollectionOnline OB Notification Forms
Measure:
• Timely completion (within 14 days) of online obstetrics prenatal and post-partum notification forms
• Online OB Notification Form Question(s)
Points are awarded if the online OB notification is completed within 14 days of the first prenatal visit.
Data CollectionOnline OB Notification Forms
Measure: At least one postpartum visit within 21 – 56 days afterdelivery
Online OB Notification Form Question(s)
Points awarded if a postpartum visit occurred within 21-56 days of the actual date of delivery
Data CollectionOnline OB Notification Forms
Measure:
A first obstetric visit within 14 days after confirmation of pregnancy
Online OB Notification Form Question(s)
Points awarded if the first prenatal visit date and the pregnancy confirmation date is within 14 days.
Data CollectionOnline OB Notification Forms
Measure:Appropriate use of 17-alpha hydroxyprogesterone when there
is prior history of singleton preterm labor
Online OB Notification Form Question(s)
Both claims and the above OB notification form questions will be utilized to award points for this measure.
Data CollectionOnline OB Notification Forms
Measure: Appropriate use of 17-alpha hydroxyprogesterone when there
is prior history of singleton preterm labor
Note: 30 points subtracted from the provider’s total if NOT used when clinically indicated.
Current ACOG guidelines for the use of 17-alpha hydroxyprogesterone will be used as a reference for this
measure.
Data CollectionOnline OB Notification Forms
Measure: Full-term, vaginal delivery after spontaneous labor whenever
medically possible.
Online OB Notification Form Question(s)
CLICK ON “For Providers”
Accessing the Provider Portal & OB Notification Forms
CLICK ON
Accessing the Provider Portal & OB Notification Forms
Please click on the icon below to access a “Provider Portal & OB Notification Form How To Guide”
Overview OB Notification Forms
• There are two types of OB Notification Forms
• Prenatal• Providers should complete this
form online within 14 days of the member’s first prenatal visit.
• Postpartum• Providers should complete this
form online within 14 days of the member’s first postpartum visit.
• Note: Interconception counseling should be a component of this PP visit.
Overview OB Notification Provider Resources
Within the Prenatal OB form there are available
evidence based resources for the provider to use
with their patients.
OB Notification Form Questions Patient/Member Demographics
OB Notification Form QuestionsPregnancy History Enter the
appropriate numerical
answer
OB Notification Form QuestionsMember/Patient Contact and First
Visit Enter the appropriate dates.
OB Notification Form QuestionsOB Provider Information & Hospital
Enter the Primary (or Attending)Prenatal Provider’s Name
Enter the name of the practice (This
can be a clinic, private practice, group practice or
FQHC)
OB Notification Form QuestionsSocial Needs Assessment & Risk
Answer Yes or No
Choose the appropriate drop down
choice
OB Notification Form QuestionsRisk Identification
Choose the appropriate drop
down choice Note: The provider can identify up to 4
risk factors.
OB Notification Form QuestionsBehavioral Health Needs
Choose the appropriate drop
down choice Note: The provider can identify up to 4
risk factors.
Answer Yes , No or Pt refused
OB Notification Form Questions17 –Hydroxyprogestrone Caproate
Screening
Answer Yes or No
Answer Yes or No
OB Notification Form QuestionsMedications
Please type in all of the patient/member’s current medicationsNote: The intensive care management team will use this information
for medication reconciliation
Submitting the Form
Enter the name of the person completing the form
Submit Date auto populates to the date the
form was completed &
submittedClick on this button ( ) to submit the form.Note: This step must be done to submit the form
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