Parameters for our Value-Based Incentive Program (VBIP), ProviDRs Care NexUS have been updated. Additionally, the number of performance measures reduce from five to four domains. These changes require no modifications to your practice as a participating primary care physician (PCP). The following is a summary of the pertinent updates, which go into effect January 1st:
Domain Changes:
Access
- If PCP does not have members eligible for pediatric or adult access, the entire incentive for the Access domain is distributed to the measures that apply. Previously, PCPs were not eligible for incentives if they did not have both pediatric and adult patients.
Quality
- Pediatricians evaluated in pediatric-only quality measures:
- Childhood immunizations
- Immunizations for adolescents
- Asthma medication ratio
- Medication management for people with asthma
- Standardized quality measure for all employers:
- Comprehensive diabetes care (CDC)
- Controlling high blood pressure (CBP)
- Breast cancer screening (BCS)
- Colorectal cancer screening (COL)
- If PCP does not have members eligible for a certain measure, the entire incentive for the Quality domain is distributed to the applicable measures. Previously, PCPs were not eligible for some incentives if certain measures did not apply.
Referrals
- Incentive payment weight increased from 20% to 40% (absorbing the Site of Service domain)
- Includes all specialty care and ancillary services
- Performance evaluated based on PMPM (per member per month) spend for specialty care. Previously, performance was evaluated based on utilization.
Site of Service
- No longer an independent domain, calculated as part of the Referrals domain
Utilization
- Performance evaluated based on PMPM (per member per month) spend for emergency room visits and inpatient hospital services. Previously, performance was evaluated based on utilization (visits per 1,000 Member Months).
- Readmissions included in inpatient PMPM spend
Other Changes:
- Available per member per month (PMPM) incentive fee increased from $5 PMPM to $6 PMPM
- 100% of performance weight based on ProviDRs Care NexUS members. Previously, 50% of performance was based on our PPO book of business for participating PCPs
- Performance benchmarks
The following documents have been updated to reflect the above changes. To view, please click on the links listed below:
If you have questions or concerns about these changes, please call (800) 801-9772, Option 2, or email us at NexUS@ProviDRsCare.Net.