Physician Performance

The clinical measures are based on physician, lab and pharmacy claims, with information pooled from both the participating physician groups and health plans. The IT measure is based on the level of electronic integration of clinical data, including claims, pharmacy, and lab or radiology results. The measure also rewards evidence of clinical decision-making at the point of care such as electronic management of prescriptions or lab results in the physicians office.
Measures represent a balance of patient satisfaction, prevention and chronic care management, and information technology (IT) investment. Measure weighting and composition evolves from year to year and is determined by the Pay for Performance Steering Committee.
Payments and Public reporting in 2005 Payments and Public reporting in 2006
Clinical Measures: Prevention and Chronic Disease Management
  • Childhood Immunizations
  • Breast Cancer Screening
  • Cervical Cancer Screening
  • Asthma
  • Coronary Artery Disease
  • Diabetes
  • Chlamydia Screening
40% Clinical Measures: Prevention and Chronic Disease Management
  • Childhood Immunizations
  • Breast Cancer Screening
  • Cervical Cancer Screening
  • Asthma
  • Coronary Artery Disease
  • Diabetes
  • Chlamydia Screening
  • Treatment of Upper Respiratory Infections
50%
Patient Satisfaction
  • Doctor-patient communication
  • Overall rating of health care
  • Specialty care access and satisfaction
  • Timely access to care
40% Patient Satisfaction
  • Doctor-patient communication
  • Overall rating of health care
  • Coordination of care
  • Specialty care access and satisfaction
  • Timely access to care
30%
Information Technology (IT)
  • Integration of electronic clinical data
  • Use of IT to manage clinical care
20% Information Technology (IT)
  • Integration of electronic clinical data
  • Use of IT to manage clinical care
20%
Total 100% Total 100%