Community QUALITY <70% quality 70% - 79% 80% - 89% 90%+ quality core measures MANAGEMENT measures met quality quality measures of quality & in each measures met in measures met in each cost domain each domain met in each domain Reporting domain Core Core measures Per capita measures quality reporting Care cost reduced quality at provider & pt coordination Community reporting level of cost core limited to local specificity effectiveness measures providers, in Core measures Pharmacy quality & aggregate quality cost cost Community improvement effectiveness improvement core measures data publicized data Community quality in aggregate publicized at core reporting to provider Community core measures local providers level measures cost quality in aggregate reporting improvement initiated data publicized at provider level Payer FINANCIAL <5% 5% 15% PBP 15% 30% >30% PBP – – participation MANAGEMENT PBP in performance- payment (PBP) payment (PBP)
Community core measures of quality & cost Reporting QUALITY MANAGEMENT <70% quality measures met in each domain Core measures quality reporting limited to local providers, in aggregate Community core measures quality reporting to local providers in aggregate 70% - 79% quality measures met in each domain Core measures quality reporting at provider & pt level of specificity Core measures quality improvement data publicized in aggregate Community core measures cost reporting initiated 80% - 89% quality measures met in each domain Care coordination cost effectiveness Pharmacy cost effectiveness Community core measures quality improvement data publicized at provider level 90%+ quality measures met in each domain Per capita cost reduced Community core measures quality & cost improvement data publicized at provider level Payer participation in performance- payment (PBP) FINANCIAL MANAGEMENT <5% payment (PBP) 5% – 15% PBP 15% – 30% PBP >30% PBP