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2013 Clinical Suites
Program Specifications
Key Program Dates
Form To Add CoQ Clinicians
2013 Clinical Suites
The Collaboration on Quality 2013 Primary Care Program has three primary components:
- Chronic clinical suites
- Preventive clinical suites
- Provider quality education
Key Points
- The provider quality education is a new component for 2013
- The generic efficiency measure has been retired for the 2013 program
- The clinical suites and measures are based on National Quality Forum (NQF) approved measures or other nationally recognized quality measures
- Each clinical suite includes a potential 2013 award for each performance measure
- The 2013 evaluation period is January 1, 2013, through December 31, 2013
| Evaluation Period: January 1, 2013 through December 31, 2013 |
| Chronic Clinical Suites |
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Diabetes - Process (ages 18 yrs and older)
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Level 1-
$500
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Level 2-
$750
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Level 3-
$1,000
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Dilated eye exam
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65%
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70%
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75%
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Microalbumin
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80%
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85%
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95%
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Diabetes - Outcome (ages 18 yrs and older)
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Level 1-
$1,000
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Level 2-
$2,000
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Level 3-
$3,000
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HgA1c < 8
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75%
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80%
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85%
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LDL < 100
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65%
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70%
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75%
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BP < 140 systolic and <80 diastolic
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65%
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70%
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75%
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Hypertension (ages 18 yrs and older)
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Level 1-
$1,000
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Level 2-
$1,500
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Level 3-
$3,000
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BP < 140 systolic and <90 diastolic
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75%
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85%
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90%
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| Preventive Clinical Suites |
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Adult Wellness, Prevention and Detection (ages 18 and older)
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Level 1-
$1,000
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Level 2-
$1,500
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Level 3-
$2,000
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BMI (every 3 yrs)
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70%
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75%
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80%
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FBS or HgA1c if BMI is > 25 (every 3 yrs)
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55%
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60%
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70%
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Framingham Risk Assessment (Ages 40 yrs and older, every 3 yrs)
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50%
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60%
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70%
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Child/Adolescent Wellness, Prevention and Detection (ages 2 - 17 years)
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Level 1-
$1,000
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Level 2-
$1,500
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Level 3-
$2,000
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Childhood Immunizations (on or before 2nd BD)
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80%
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85%
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90%
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Body Mass Percentile (ages 3-17 yrs)
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80%
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85%
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90%
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| Provider Quality Education |
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Clinician must attend three (3) one (1) hour Wellmark sponsored quality education sessions during the evaluation period. The sessions will be webinars and will be recorded. Clinician may attend live webinar or recorded webinar.
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$500 per CoQ participating clinician
Clinician must attend all three sessions in their entirety and submit written attestation by end of evaluation period
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Program Specifications
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Collaboration on Quality 2013 Primary Care Program
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Measures Tied to Financial Awards
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Clinical Award
- Adult Wellness, Prevention and Detection (ages 18 and older)
- Child/Adolescent Wellness, Prevention and Detection (ages 2-17 years)
- Diabetes - Process Measures (ages 18 yrs and older)
- Diabetes - Outcome (ages 18 yrs and older)
- Hypertension
Provider Quality Education
- Attend three one hour Wellmark-sponsored quality education sessions
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Performance Calculation
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- Financial measures for each clinical suite are calculated based on the aggregate performance of all clinicians participating at a clinic site. A clinic site is a clinician’s designated primary location (physical address) where the clinical provides services.
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Payment for ARNPs and PAs
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- ARNPs and PAs will be awarded 85 percent of the listed award amount in all cases.
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Minimum Requirements for Clinical Suite Award Eligibility
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- To meet Levels 1, 2 or 3, clinicians participating at a physical clinic site must meet the specified percentage for every measure listed within the clinical suite.
- Where multiple measures are included in a single suite, the lowest performance level achieved is the overall performance level achieved for that clinical suite.
- Each clinician is required to have at least one Wellmark member in at least one clinical suite at the Program’s year-end to be eligible for a clinical suite financial award.
- For the Diabetes clinical suite, providers can earn a Process Measure Award and an Outcome Measure Award.
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Minimum Requirements for Provider Quality Education
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- The CoQ clinician must attend three 60 minute Wellmark sponsored quality education sessions during the evaluation period
- Anticipated dates are April, July and October
- The sessions will be webinars and will be recorded
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Minimum Requirements for Data Processed
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- Program participant is responsible for timely submission of records on an ongoing basis. Any award to be paid to the Program participant shall be reduced by $250 per professional who has records processed by the third-party vendor less frequently than once per month for six out of 12 calendar months of the evaluation period.
- This is a one-time reduction per professional for the Program year.
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Minimum Requirements for Blood Pressure Values
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- Blood pressure values are to be submitted to the third-party vendor for each physical exam visit, preventive visit, or clinician visit related to chronic diabetes and/or hypertension. If blood pressure values are not submitted for one or more of the above described exams, the Clinical Award to Program participant shall by reduced by $250 per professional.
- This is a one-time reduction per professional for the Program year.
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Key Program Dates
| Date |
Deadline |
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December 31, 2012
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Last day to request new clinicians be added to 2013 program
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January 1, 2013
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2013 program start date
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August 31, 2013
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Last day to add patients to 2013 program
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December 31, 2013
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Program end date
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January 31, 2014
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Last day to submit data
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