Provider Alerts

HEDIS Measure

HPSJ Incentive Program

Reward

Next Steps 2016

1. Cervical Cancer Screening – CCS

Women 21-64 years of age who are screened for cervical cancer

1. 21-64 cervical cytology done every 3 years
2. 30-64 cervical cytology /HPV co-testing done every 5 years

Mailer to all eligible members includes description of incentive. Member visits doctor. If provider signs the form or we have a claim; member gets incentive.

$25 Walmart gift card.

1. In 2016 we are providing an incentive to the member and the provider
2. Provider Services and Quality management are partnering to perform provider visits and trainings related to improving HEDIS outcomes.

Prenatal Care – PPC
Prenatal care visit in the first trimester or within 42 days of enrollment into the health plan

Mailer to all eligible members includes description of incentive. Member visits doctor. If provider signs the form or we have a claim; member gets incentive.

$25 Walmart gift card.

1. In 2016 we are providing an incentive to the member and the provider
2. The prenatal program was started in April 2016 to reach members during each trimester.
3. Provider Services and Quality management are partnering to perform provider visits and trainings related to improving HEDIS outcomes.

Postpartum Care – PPC
Postpartum visit done between 21 and 56 days (3-8wks) after date of delivery.

Mailer to all eligible members includes description of incentive. HPSJ also does live outreach calls to moms. Member visits doctor. If provider signs the form or we have a claim; member gets incentive.

$25 Walmart gift card.

1. In 2016 we are providing an incentive to the member and the provider
2. The postpartum program was started in April 2016 to reach members who have delivered and remind them to make their appointment.
3. Provider Services and Quality management are partnering to perform provider visits and trainings related to improving HEDIS outcomes.

Well-Child Exam W34
Members 3-6 years old, who had one or more well-child visits with a PCP.

Mailer to all eligible member/parents each year. Member visits doctor. If provider signs the form or we have a claim; member gets incentive.

$20 movie theater gift card.

1. In 2016 we are providing an incentive to the member and the provider
2. PR and QM are partnering to perform provider visits and trainings related to improving HEDIS outcomes.
3. The incentive to get a well-child exam impacts additional measures; 
1. CAP (Children and Adolescent Access to PCP)
2. IMA (Immunizations for Adolescents)
3. HPV (Human Papillomavirus Vaccine)
4. CIS (Childhood Immunization Status)
5. WCC (Weight Assessment and Counseling for Nutrition and Physical Activity)

Comprehensive Diabetes Care – Eye Exam and Hemoglobin A1c testing
Members 18-75 years old with type 1 or type 2 must have the following:

1. Hemoglobin A1c test
2. Retinal eye exam (i.e. Diabetic eye exam)

Mailer to all eligible members includes description of incentive. Member completes screenings. If provider/lab signs the form or we have a claim; member gets incentive.

$20 movie theater gift card.

1. In 2016 we are providing an incentive to the member and the provider
2. Quality management is partnering with VSP to conduct Diabetic clinics at select provider offices.
3. Provider Services and Quality management are partnering to perform provider visits and trainings related to improving HEDIS outcomes.