Obstetrical Pay For Performance

Introduction • The Department of Social Services is introducing a Pay for

Performance (P4P) Program in obstetrics care, beginning August 1, 2013.

• The purpose of this program is to improve the care for pregnant women and the outcomes of their newborns covered under the HUSKY Health programs.

• A total of $1.2 million was appropriated by the Connecticut General Assembly to be paid to providers of obstetric care in State Fiscal Year 2015. Obstetrical P4P payments are in addition to current fee for service payments.

Eligible Providers

• Providers eligible to participate in the obstetric P4P Program are providers currently enrolled as family medicine physicians, obstetrician/gynecologists, obstetric nurse practitioners, family medicine nurse practitioners, physician assistants and certified nurse midwives enrolled in the Connecticut Medical Assistance Program (CMAP) network and providing obstetric care to eligible Husky Health and Charter Oak Health Plan clients.

Performance Measures • The following performance measures (with their associated point values)

are those for which the Department will provide incentive payments:Performance Measure Point Value

Timely completion (within 14 days) of online obstetrics prenatal and post-partum notification forms

5

A first obstetric visit within 14 days after confirmation of pregnancy 25

At least one postpartum visit within 21 – 56 days after delivery 25

Full-term, vaginal delivery after spontaneous labor whenever medically possible.

30

Appropriate use of 17-alpha hydroxyprogesterone when there is prior history of singleton preterm labor NOTE: 30 points if used when indicated;

30

NOTE: 30 points subtracted from the provider’s total if NOT used when clinically indicated.

-30

Evaluating Provider Performance

Data on provider’s performance on the above measures will be collected from claims and from the obstetrics notification forms.

Only episodes of care for which providers use the online obstetrics notification forms will be eligible for the P4P Program.

Data CollectionOnline OB Notification Forms

Measure:

• Timely completion (within 14 days) of online obstetrics prenatal and post-partum notification forms

• Online OB Notification Form Question(s)

Points are awarded if the online OB notification is completed within 14 days of the first prenatal visit.

Data CollectionOnline OB Notification Forms

Measure: At least one postpartum visit within 21 – 56 days afterdelivery

Online OB Notification Form Question(s)

Points awarded if a postpartum visit occurred within 21-56 days of the actual date of delivery

Data CollectionOnline OB Notification Forms

Measure:

A first obstetric visit within 14 days after confirmation of pregnancy

Online OB Notification Form Question(s)

Points awarded if the first prenatal visit date and the pregnancy confirmation date is within 14 days.

Data CollectionOnline OB Notification Forms

Measure:Appropriate use of 17-alpha hydroxyprogesterone when there

is prior history of singleton preterm labor

Online OB Notification Form Question(s)

Both claims and the above OB notification form questions will be utilized to award points for this measure.

Data CollectionOnline OB Notification Forms

Measure: Appropriate use of 17-alpha hydroxyprogesterone when there

is prior history of singleton preterm labor

Note: 30 points subtracted from the provider’s total if NOT used when clinically indicated.

Current ACOG guidelines for the use of 17-alpha hydroxyprogesterone will be used as a reference for this

measure.

Data CollectionOnline OB Notification Forms

Measure: Full-term, vaginal delivery after spontaneous labor whenever

medically possible.

Online OB Notification Form Question(s)

CLICK ON “For Providers”

Accessing the Provider Portal & OB Notification Forms

CLICK ON

Accessing the Provider Portal & OB Notification Forms

Please click on the icon below to access a “Provider Portal & OB Notification Form How To Guide”

Overview OB Notification Forms

• There are two types of OB Notification Forms

• Prenatal• Providers should complete this

form online within 14 days of the member’s first prenatal visit.

• Postpartum• Providers should complete this

form online within 14 days of the member’s first postpartum visit.

• Note: Interconception counseling should be a component of this PP visit.

Overview OB Notification Provider Resources

Within the Prenatal OB form there are available

evidence based resources for the provider to use

with their patients.

OB Notification Form Questions Patient/Member Demographics

OB Notification Form QuestionsPregnancy History Enter the

appropriate numerical

answer

OB Notification Form QuestionsMember/Patient Contact and First

Visit Enter the appropriate dates.

OB Notification Form QuestionsOB Provider Information & Hospital

Enter the Primary (or Attending)Prenatal Provider’s Name

Enter the name of the practice (This

can be a clinic, private practice, group practice or

FQHC)

OB Notification Form QuestionsSocial Needs Assessment & Risk

Answer Yes or No

Choose the appropriate drop down

choice

OB Notification Form QuestionsRisk Identification

Choose the appropriate drop

down choice Note: The provider can identify up to 4

risk factors.

OB Notification Form QuestionsBehavioral Health Needs

Choose the appropriate drop

down choice Note: The provider can identify up to 4

risk factors.

Answer Yes , No or Pt refused

OB Notification Form Questions17 –Hydroxyprogestrone Caproate

Screening

Answer Yes or No

Answer Yes or No

OB Notification Form QuestionsMedications

Please type in all of the patient/member’s current medicationsNote: The intensive care management team will use this information

for medication reconciliation

Submitting the Form

Enter the name of the person completing the form

Submit Date auto populates to the date the

form was completed &

submittedClick on this button ( ) to submit the form.Note: This step must be done to submit the form

We are here to help !