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JPA-BCN GROUP INCENTIVES
The Jackson Physicians Alliance (JPA) has negotiated a number of group incentives as part of its contract arrangement with BCN. As a JPA – BCN member, you may receive incentive money from these contracted performance arrangements. To be eligible, you must first be a member in the JPA – BCN contract for six months of the incentive year. Incentive payouts are based upon your performance relative to the incentive goals. |
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RISK POOLS A minimum withhold is taken on all submitted claims. The withhold is distributed evenly among three different Risk Pools. The risk pools for 2010/11 are: 1. Decreased Utilization/Thousand (220/K) for Outpatient Surgery. This is any procedure not done in the office or while the member is an Inpatient in a hospital. 2. Decreased Utilization/Thousand (176/K) for Emergency Rooms visits. Any claim for which an emergency room visit is received. 3. JPA Group score for BCN’s Performance Recognition Program (PRP)> 80%. PRP is an incentive program built around HEDIS Indicators and BCN Quality Measures. Please see BCN Pay for Performance Programs for more information.
PHARMACY INCENTIVE A Pharmacy incentive has been set up within the JPA – BCN contract. The two goals must both be met to attain incentive monies: 1. Increase the percentage of Generic Drugs prescribed (≥78%) AND decrease the pharmacy cost per/member/ per/month ($44.30); AND 2. Increase Generic Utilization of Anti-ulcer (≥84%) and Lipotropic (≥73%) categories.
BCN Pay for Performance Programs
Health eBlue Health eBlue is a website Blue Care Network has set up to assist physicians with meeting the Pay for Performance goals. At least one person from each office should have access to the site (an application must be completed). JPA can assist with Training on navigating the site. The Pay for Performance program is broken down into three components: · Base Performance Recognition (PRP) · PRP Bonus · Pay As You Go
Base PRP A Quality Composite Score for PCPs. Measures are HEDIS Indicators and BCN Quality Measures ( i.e.: Diabetic testing Measures, immunizations, well-child visits, colorectal screening, breast cancer screening, cervical cancer screening, cholesterol mgmt for cardiovascular disease patients) Payouts depend on the composite score target rate and start at $0.75 pm/pm to $2.25 pm/pm)
PRP Bonus In 2011, BCN is offering five PRP bonus initiatives for commercial and BCN Advantage members. Technical specification documents, which detail timeframes, measures and payments, are available on Health e-Blue.
Pay As You Go (PAYG) These initiatives are changed yearly. In 2011, the PAYG initiatives are also found in the base PRP, with the expectation of the breast cancer and colorectal screenings. Payments are made to the physician in the fall 2011 and the spring 2012. During the first 6 months of the year the physician has the potential to earn $5 per exam, test or screening and then the second payment is based on your final Composite score up to $15 per exam, test or screening.
Click Here for additional highlights on the 2011 Base PRP, Blue Reward and PAYG OR Log on to the Health eBlue website and view the full 2011 BCN Incentive Document under resources |