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Wellmark's Collaboration on Quality® Primary Care Program recognizes participating primary care clinicians in Iowa and South Dakota who provide care in line with nationally recognized measures of care.
Program participants have agreed to share their performance information with members, employers, and other providers. This information is found in Wellmark’s online directory.
Clinicians who meet performance levels for program components are eligible for special recognition, including potential financial rewards.
Please note: Although these participants have met the program criteria, this does not imply any guarantee of positive outcome or endorsement by Wellmark. In addition, coverage for services provided by a clinician to satisfy program measures is determined by the terms of each member’s benefit certificate or policy.
2010 Primary Care Program Performance Level Descriptions
Performance levels are based on the performance of the clinic rather than the individual clinician:
Level 1: This clinic has achieved the baseline performance level for this measure.
Level 2: This clinic exceeds Level 1 performance for this measure.
Level 3: This clinic meets the highest program performance levels for this measure.
Clinics achieve level 1, 2, or 3 based on their average performance using the measures and outcomes outlined in the following tables.
2010 Program Measures
| DIABETES - Ages 18 years and older |
| Process Measure |
Performance Level: Minimum % |
|
Level 1
|
Level 2
|
Level 3
|
| HgA1c Test 1 annually |
85%
|
90%
|
94%
|
|
Lipid Profile (LDL) every 12 months
(at least 1 low-density lipoprotein test) |
85%
|
90%
|
94%
|
|
Microalbumin every 12 months
(or evidence of medical attention for existing nephropathy) |
75%
|
80%
|
90%
|
|
Dilated Eye exam every 12 months.
(by an optometrist or ophthalmologist) |
60%
|
65%
|
70%
|
| Body Mass Index (BMI) |
80%
|
85%
|
90%
|
| Outcome Measures |
|
| Proportion w/HgA1c less than 8 |
70%
|
75%
|
80%
|
| Proportion w/LDL less than 100 |
60%
|
65%
|
70%
|
|
Proportion w/BP less than 140 systolic and less than 80 diastolic
Blood pressure check each visit
|
60%
|
70%
|
75%
|
| HYPERTENSION - Ages 18 years and older |
| Process Measure |
Performance Level: Minimum % |
|
Level 1
|
Level 2
|
Level 3
|
| BMI (Body Mass Index) |
80%
|
|
|
| Outcome Measures |
|
|
Proportion w/BP less than 140 systolic and less than 90 diastolic
Blood pressure checked each visit |
75%
|
80%
|
85%
|
| CHILDHOOD IMMUNIZATIONS – Age 2 years during the calendar year |
| Process Measure |
Performance Level: Minimum % |
|
Level 1
|
Level 2
|
Level 3
|
|
Children turning two in 2010 who receive 4 DTaP, 3 IPV, 1 MMR, 4 HIB, 3 HEP-B, 1 VZV, 4 pneumococcal conjugate vaccines on or before second birthday.
|
75%
|
|
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| ASTHMA - No age range |
| Process Measure |
Performance Level: Minimum % |
|
Level 1
|
Level 2
|
Level 3
|
|
Percentage of members with asthma who were classified during the evaluation period using National Asthma Educational and Prevention Program (NAEPP) guidelines.
|
70%
|
|
|
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Percentage of members with persistent asthma prescribed either the long-term control medication (inhaled corticosteroid) or an acceptable alternative steroid sparing control medication.
|
80%
|
90%
|
95%
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Collaboration on Quality®
The Collaboration on Quality program is a collaboration between Wellmark and Network clinicians designed to:
- measure and calculate clinicians’ performance,
- support clinicians’ efforts to improve the delivery of health care,
- provide information to support and inform clinicians, and
- share information with the public regarding a clinician’s participation and performance in the program.
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