SLIDE 13 Primary Care Quality & Efficiency Outcome Scorecard Principal Weight=50%
Diabetic Foot Exam completion Physician Composite Star Rating for Blue Advantage, Humana and HealthSpring- 3 stars BP Control- Increase the percentage of individuals 18-65 years of age with a diagnosis of hypertension whose BP was adequately controlled (<140/90) during the previous 12 months. 65 or older BP was adequately controlled (≤ 150/90) Breast Cancer Screening-members who are female between 50-74 years of age who had a mammogram to screen for breast cancer during the measurement year or the prior year. Colorectal Cancer Screening-members who are between 50-75 years of age who had appropriate screening for colorectal cancer. A1c Control- Diabetes, provider must ensure that eligible patients most recent A1c is no greater than 8. Red, White & Blue Medicare Wellness visits Reduce COPD Readmissions less than or equal to 6% Provider must exceed the performance standard for their assigned member population. The readmission rate = (# of readmissions) / (# of admissions). This includes inpatient admissions to any facility exclusive of psychiatry, maternity, SNF and rehabilitation visits Completion of Medicare & Medicare Advantage Forms
Service-Principal Weight=25%
In the last 12 months, when you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed? Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider? In the last 12months, how often did this provider spend enough time with you?
Financial Performance -Principal Weight=25%
Meet budgeted expenses Achieve coding accuracy Medical Records completed within 7 days
