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 incentivePoint
payments:
Performance
Measure
Value
Timely completion (within 14 days) of online obstetrics prenatal and postpartum 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 Collection
Online 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 Collection
Online OB Notification Forms
Measure:
At least one postpartum visit within 21 – 56 days after
delivery
Online OB Notification Form
Question(s)
Points awarded if a postpartum visit occurred within 21-56 days
of the actual date of delivery
Data Collection
Online 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 Collection
Online 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 Collection
Online 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 Collection
Online OB Notification Forms
Measure:
Full-term, vaginal delivery after spontaneous labor whenever
medically possible.
Online OB Notification
Form Question(s)
Accessing the Provider Portal & OB
Notification Forms
CLICK ON “For Providers”
Accessing the Provider Portal & OB
Notification Forms
CLICK
ON
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 Questions
Pregnancy History
Enter the
appropriate
numerical
answer
OB Notification Form Questions
Member/Patient Contact and First
Visit
Enter the appropriate dates.
OB Notification Form Questions
OB 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 Questions
Social Needs Assessment & Risk
Answer Yes or No
Choose the
appropriate
drop down
choice
OB Notification Form Questions
Risk Identification
Choose the
appropriate drop
down choice
Note: The provider
can identify up to 4
risk factors.
OB Notification Form Questions
Behavioral Health Needs
Answer Yes , No
or Pt refused
Choose the
appropriate drop
down choice
Note: The provider
can identify up to 4
risk factors.
OB Notification Form Questions
17 –Hydroxyprogestrone Caproate
Screening
Answer Yes or No
Answer Yes or No
OB Notification Form Questions
Medications
Please type in all of the patient/member’s current
medications
Note: The intensive care management team will use this information
for medication reconciliation
Submitting the Form
Enter the name of the person completing the form
Click on this button (
submit the form.
) to
Note: This step must be done to submit the form
Submit Date
auto populates
to the date the
form was
completed &
submitted
We are here to help !