To VHCN Providers:

In our continued efforts to reward quality medical care VHCN has added Specialty Quality Measures to our P4P program for specialist physicians. The quality measures are based on evidence based guidelines, which are recommended by national quality initiative organizations such as the Ambulatory Care Quality Alliance (AQA), National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), Physician Quality Reporting Initiative (PQRI), Health Plan Employer Data Information Set (HEDIS) and individual specialty associations.

Each physician’s individual performance will be evaluated on specific specialty quality measures* which will include information gathered from claims data, Medical Staff Services, VBMC Quality Initiative Program reports and from various clinical departments.

To qualify for participation in the 2007-2008 P4P Quality Performance Program, physicians must meet the following criteria:

1. PCP’s must have Valley Health Plan panel size of fifty (50) or more members
2. Specialists must have Valley Health Plan patient contacts of twenty-five (25) members or more
3. Physicians must participate in Valley Health Plans provider network and be members of Valley Health Care Network

Physicians can receive additional credit for the following:

1. Percentage of Generic Drug prescriptions above the mean for their peer group
2. Complication Rate below benchmarks
3. Re-admission Rate below benchmarks
4. Mortality Rate below benchmarks
5. PQRI Participation
6. EMR Participation (any certified system)

*(Quality measures are subject to modification during the measurement year as needed and subject to P4P team reviews).

For additional information please call:
Valley Health Care Network at (956) 389-6742

Quality Measures