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MESA COUNTY PHYSICIANS IPA INCENTIVE PROGRAM The Incentive Program for Mesa County Physician IPA (MCPIPA) has been developed to meet criteria established by the general membership of our association. Funding for this program is contractual through the Medical Services Agreement between MCPIPA and Rocky Mountain HMO. The distribution of incentive monies is based on criteria mutually agreed upon between both parties for programs based on the chronic care or clinical model and community-based initiatives. In a typical year, the incentive program averages approximately $1.0 million dollars. The Incentive Program is comprised of three components: Quality Health Network (QHN) one-sixth (1/6 th ) of the incentive dollars received quarterly is allocated to QHN to offset access fees for our physician members. Continuation of this benefit is voted on annually at the meeting of the general membership. Reward for Participation (R4P) one-sixth (1/6 th ) of the incentive dollars is allocated and paid quarterly to those physician members who participate in MCPIPA programs designed to enhance Education and Quality Improvement Programs. General Incentive two-thirds (2/3) of the incentive dollars are allocated and paid quarterly to our physician members. The incentive monies are distributed through two separate funding pools: Primary Care and Specialists. Reward For Participation 1/6 Quality Health Network 1/6 General Incentives 2/3

INCENTIVE PROGRAMS QUALITY HEALTH NETWORK (QHN) one-sixth (1/6 th ) of the incentive dollars is allocated each quarter to QHN to offset access fees for MCPIPA member physicians as a benefit of membership. Continuation of this program and payment distribution is voted on annually by the MCPIPA general membership. The MCPIPA Board of Directors approves each quarterly payment. REWARD FOR PARTICIPATION (R4P) One-sixth (1/6 th ) of the incentive dollars is allocated and paid quarterly to those physician members who voluntarily participate in R4P approved Education and Quality Programs. The purpose of the Reward for Participation program is to improve the quality and cost efficiency of medical care in Mesa County through enhanced support of the IPA s mission and goals as well as a motivation to increase participation in the IPA s programs and projects by the membership. R4P is available to all members who participate at any level based on their personal choice. The R4P program was redesigned at the request of the IPA Board in response to positive feedback from our member physicians who attended the Focus Groups held in the summer of 2014. Effective January 1, 2015, the R4P Program will move from a CME attendance based model to supporting programs more directly connected to the IPA. The R4P program will consist of quarterly meetings with a focus on matters of interest to IPA physician members, followed by an opportunity for break-out sessions for physicians to discuss various topics. Topics will cover issues that relate to improving the cohesion, cooperation, and effectiveness of the physician community as a whole. This adjustment to the R4P Program is intended to broaden the audience of physicians who engage in R4P, improve collaboration, and provide a meaningful engine for achieving initiatives that matter to IPA physicians. Meetings The R4P meetings will be held quarterly at a local venue such as The DoubleTree Hotel or similar location. An agenda including discussion topics and meeting details will be sent in advance of each meeting. Meeting times: 5:30 6:00 Dinner 6:00 6:30 MCPIPA Business meeting 6:30 7:30 Breakout Sessions 2015 Schedule: Tuesday January 27, 2015 Annual Membership Meeting Tuesday May 19, 2015 2Q2015 R4P Quarterly Meeting Tuesday August 18, 2015 3Q2014 R4P Quarterly Meeting Tuesday November 17, 2015 4Q2015 R4P Quarterly Meeting Agenda Topics: We value your input and hope you will share ideas for discussion topics for the break-out sessions. Please contact the IPA with your suggestions. The clinical topic at each quarterly meeting may be further developed at the next quarterly meeting if warranted based on interest expressed by the physicians. Compensation Under this new R4P Program, MCPIPA member physicians will only be compensated for their attendance or presentation at the quarterly meeting. Attendance Compensation: MCPIPA member physicians who attend the R4P quarterly meetings will receive a flat rate per meeting. Please see the Budget and Determination of Compensation below for potential compensation. Policies and procedures for attendance will be developed by the IPA. Presenter Compensation: MCPIPA member physician who presents a topic and lead the discussion will be compensated at the flat rate of $500.

Budget and Determination of Compensation The R4P budget is funded by allocating 1/6 of the total IPA incentive dollars. Based on historical data from 4Q2013-3Q2014, the average R4P dollars available for distribution each quarter was approximately $62,270. Using the amount of $62,270 the calculation methodology would be as follows: REVENUE TOTAL AMOUNT RECEIVED THIS QUARTER $62,270.00 EXPENSES Facility for meeting and cost of food and drink $11,500.00 Based on average of 150 attendees Compensation to IPA Physicians Member presenters $2,000.00 Based on $500 flat rate to each presenter; two presenters per breakout session; two different break-out sessions per quarterly meeting Sub-total Expenses $13,500.00 Revenue less Expenses or Amount to be Distributed to Attendees $48,770.00 Number of Physician Attendees: Based on average of 150 physicians which is historical attendance at the Annual Meetings 150 Potential Flat Rate for Attendance at this quarterly meeting $325.13 Please note: The program changes described herein are contingent on IPA membership approval at the meeting scheduled for January 27, 2015. The Monthly All Physician meetings hosted by MCPIPA and held on the second Wednesday of each month at Community Hospital will no longer be held and will replaced with the R4P Quarterly Meeting. The IPA will not compensate IPA member physicians for their attendance at local CME events such as the St. Mary s Grand Rounds held on Tuesday mornings, the Friday morning Community Hospital sessions, or the Regularly Scheduled Sessions such as the Rad-Path Conference, the Ortho Journal Club or the Breast Cancer Conference. Because compensation will be paid several months after each meeting it is not possible to determine the flat rate attendance amount in advance. The Incentive Program contribution from Rocky Mountain Health Plans is generally received the early in the second month following the end of a quarter. For example, the first quarter (ending March 31) is generally received in early May; second quarter in August, etc. Going forward under this new program, all expenses relating to the quarterly meetings such as food, drink, venue costs, presenters, etc., will be paid out of the R4P incentive fund and remaining dollars will be shared equally among the attendees. The entire amount received will be paid out each quarter. The IPA plans to increase access to and involvement in R4P programs by initiating the changes described above. During the time frame 4Q2013 3Q2014, based on the point system: o 29 MCPIPA member physicians shared 215 different presentations. o Based on top points - 26 MCPIPA member physicians received an amount greater than $1,800 based on their attendance and/or presentation points which were equal to or greater than 20. o Based on top dollars 53 MCPIPA member physicians received total compensation greater than $1,000.

GENERAL INCENTIVE two-thirds (2/3) of the incentive dollars are paid quarterly to physicians for their participation in specialty specific incentive programs. The total available dollars are divided by the total number of participating physicians to determine the baseline allocation. Two separate pools of money are created for distribution: Primary Care and Specialists. The amount of dollars available for each of the two pools is determined by the baseline physician allocation multiplied by the number of physicians in each pool. Disclaimer - Incentives are paid as indicated in the criteria described in this document and as determined by the Quality Value and Outcomes (QVOC)) and the Physician Incentive and Engagement Committee (PIE), in cooperation with the leadership group at Rocky Mountain Health Plans (RMHP). The QVOC, with RMHP leadership and the PIE, will determine the Incentive Program guidelines and the application of the guidelines to the particular situations. The MCPIPA Board of Directors will review the activities of the QVOC and PIE quarterly. The QVOC and PIE, with approval of the MCPIPA Board of Directors, may make adjustments to the Incentive Plan as they deem necessary to reach the goals and objectives of the program. The terms of the Program, can be changed or discontinued at the discretion of the MCPIPA Board of Directors.

2015 Incentive Program Primary Care Physicians Incentive Measure Referral Measure - Enhance communication across the Medical Neighborhood between physicians All Primary Care Physicians including Family Medicine, Internal Medicine and Pediatric specialties Value: 100% of total incentive Effective Period: January 1 December 31, 2015 Calculation Method: Meets or exceeds benchmark Any changes to the criteria are made by and through the appropriate MCPIPA committee(s) approval. Adequate notice is to be given to the membership prior to implementation. This is a collaborative arrangement with Rocky Mountain Health Plans (RMHP) and Mesa County physicians IPA (MCPIPA). Assessment process: 1Q 2015 Conduct Self-Assessment Each physician conducts a self-assessment on his/her referrals. MCPIPA provides a Scoring Tool to perform a self-assessment on five (5) referrals sent to a consulting physician during the time frame January 1 through March 31, 2015. This self-assessment identifies opportunities for improving referral requests. The Opportunity for Improvement Tool provided by MCPIPA states goals for improvement based on the results of self-assessments. Goal: Reflect a measurable change. For example, ensure that all supporting documentation accompanies the referral when it is sent to the consulting physician on 100% of referrals. Submit to MCPIPA: The Scoring Tool and Opportunity for Improvement Tool for each of the five (5) referrals. Due Date: April 15, 2015 2Q2015 Peer Review Primary Care Physicians send three (3) referrals completed during the time frame January 1 to March 31, 2015, to MCPIPA by April 30, 2015. These referrals must be de-identified (no patient information) and include the documentation that was sent with the referral. The IPA de-identifies the physician and practice name and chooses a physician from a like specialty (Internal Medicine to Internal Medicine, Pediatrics to Pediatrics, etc.) to review the referral and documents and provide feedback using the Scoring Tool. The identity of the physician being reviewed will not be revealed to the reviewer. The IPA forwards these documents to the reviewing physician by mid-may 2015. The reviewing physician completes the review and returns the documents to MCPIPA by June 30, 2015. The Scoring Tool for each of the three referrals are returned to the referring physician by July 15, 2015. Submit to MCPIPA: Primary Care Physician will send three (3) referrals. Due Date: April 30, 2015 Submit to MCPIPA: Reviewing Physician will return the Scoring Tool for each of the three (3) referrals. Due Date: June 30, 2015 3Q2015 Opportunity for Improvement Tool Each physician conducts a second self-assessment on referrals sent to a consulting physician during the time frame July 1 through September 30, 2015. The physician completes the Scoring Tool for self-assessment on five (5) referrals to determine if improvement has occurred based on the stated goals from 1Q2015 and feedback received from the Peer Review in the second quarter. Compare the results from 3Q2015 to the goal identified in 1Q2015. Submit to MCPIPA: The Scoring Tool and Opportunity for Improvement Tool with third quarter results for each of the five (5) referrals. Due Date: October 15, 2015 4Q 2015 Pre-Visit Collaboration Using two (2) referrals during the time frame October 1 through December 31, each primary care physician contacts the specialist or consulting physician to discuss the proposed referral. The specialist or consulting physician provides a pre-emptive review to determine the appropriateness of the referral. The primary care physician uses the Pre-Visit Collaboration Tool to document the discussion with the consulting physician. Submit to MCPIPA: The Pre-Visit Collaboration Tool used on each of the two (2) referrals. Due Date: January 15, 2016 NOTE: This is the only incentive measure for primary care physicians in 2015.

SCORING TOOL 1Q2015, 2Q2015 and 3Q2015 Primary Care Physician Name of Physician being Reviewed: Name of Reviewing Physician: Date: Circle quarter covered by this tool: 1Q 2Q 3Q To meet requirements for: 1Q Submit self-assessment of five (5) referrals. Complete Scoring Tool in its entirety for each referral and the Opportunity for Improvement Tool with your stated goal. 2Q Submit three (3) referrals for Peer review (blinded). Reviewing physician will complete Scoring Tool in its entirety for each referral reviewed. 3Q Submit Opportunity for Improvement Tool using 1Q and 2Q Scoring Tools and results from peer review. 4Q Submit Pre-Visit Collaboration Tool on two (2) referrals. Indicator of Patient Being Reviewed: (Please de-identify chart under review; use a number rather than patient name). Use the following criteria to perform assessments as required for each quarter in 2015. 1. Timeliness of referral - in the patient s clinical course was the referral initiated: Too soon Just right Too late 2. Appropriateness of the referral - a. From your medical perspective, do you think this referral was appropriate to send to the identified specialty? Yes No Please elaborate: b. Based on the content of the referral can you conclude what the referring physician intended to gain or determine by initiating the referral? Yes No Please elaborate:

OPPORTUNTY FOR IMPROVEMENT TOOL 1Q2015 and 3Q2015 Primary Care Physician Please identify which quarter you are completing this measure by checking the appropriate box. 1Q2015 Use the Scoring Tools from 1Q2015 to determine a baseline and any changes and improvements in referral behaviors. This incentive measure is due April 15, 2015 3Q2015 Use the Scoring Tools from 1Q2015 and 2Q2015 to determine changes and improvements in referral behaviors. This incentive measure is due by October 15, 2015 To meet requirements for: 1Q Submit self-assessment of five (5) referrals. Complete Scoring Tool in its entirety for each referral and the Opportunity for Improvement Tool. 2Q Submit three (3) referrals for Peer Review (blinded). Reviewing physician will complete Scoring Tool in its entirety for each referral reviewed. 3Q Submit Opportunity for Improvement Tool using results of 1Q and 2Q Scoring Tool. 4Q Submit Pre-Visit Collaboration Tool on two (2) referrals. 1Q2015: Due April 15, 2015 State your goal for improvement based on the results of your selfassessments. The goal should reflect a measurable change. For example ensure that all supporting documentation accompanies the referral when it is sent to the consulting physician on 100% of referrals: 3Q2015: Due October 15, 2015 Use the Scoring Tool provided to perform a self-assessment on five (5) referrals to determine if improvement has occurred based on your goal from 1Q2015 stated above and the results of the Peer Review conducted in 2Q2015. Compare your results from 3Q2015 to the goal identified in 1Q2015. Knowing those results, what changes will you make now? Based on the results of the 1Q and/or 2Q Scoring Tools I would (please print clearly) Physician Name: Practice Name: Date:

PRE-VISIT COLLABORATION TOOL 4Q2015 Primary Care Physician Name of Referring Physician: Date: Name of Consulting Physician: In an effort to move towards collaborative care, the 4Q2015 activity requires the PCP s to reach out to a Specialist or Consulting Physician. Use the following criteria to perform assessment for 4Q2015. 1. Have you chosen the right specialty for this referral? Yes No Please elaborate: 2. What detail did you share with the consulting physician so they could make an informed decision? Please elaborate: 3. What information did the consulting physician provide that would help you determine the next steps? Please elaborate: 4. When does the patient need to be seen or need an appointment? Patient does NOT need to be seen First Available Appointment As Soon As Possible Emergent Other 5. Is there more you should do before the sending the referral? For example, additional testing, therapeutic trial, etc. Yes No Please elaborate:

A Quick Review for 2015 Referral Measure Primary Care Physicians 1Q 2015: Self-Assessment Conduct Self-Assessment on five (5) referrals and review opportunities for improvement in the referrals you have sent to a consulting physician. After reviewing your self-assessment scoring, use the Statement of Improvement to state your goal for improvement. Submit the Opportunity for Improvement Tool and the Scoring Tool for each of the five referrals to MCPIPA by April 15, 2015. 2Q2015: Peer Review A fellow physician will review referrals you sent during the time frame January 1 to March 31. Patient detail will be blinded and the reviewing physician will not know which physician he is reviewing. The reviewing physician will use the Scoring Tool for each of the three (3) referrals to provide feedback and identify any opportunities for improvement. Referring Physician will submit three (3) blinded referrals for review to the IPA and the Reviewing Physician will complete the Scoring Tool for each of the three (3) referrals and include feedback to MCPIPA by June 30, 2015. The IPA will return the detail back to the referring physician by July 15, 2015. 3Q2015: Evaluation for Improvement Use the Scoring Tool provided to perform a self-assessment on five (5) referrals during the time frame July 1 to September 30. Use the results of the Scoring Tool to determine if improvement has occurred based on your stated goal from 1Q2015 and the feedback from the Reviewing Physician in the second quarter. Submit your Opportunities for Improvement Tool with third quarter results and the Scoring Tool for each of the five (5) referrals to MCPIPA by October 15, 2015. 4Q 2015: Pre-Visit Collaboration Using two (2) referrals during the time frame October 1 to December 31, the primary care physician will contact the specialist or consulting physician to discuss the proposed referral. The Specialist or consulting physician will provide a pre-emptive review to determine the appropriateness of the referral. Submit the completed Pre-Visit Collaboration Tool for each of the two (2) referrals to MCPIPA by January 15, 2016.

2015 Incentive Program Specialty Physicians Incentive Measure Referral Measure All specialty physicians; exceptions listed below Value: 100% of total incentive Effective Period: January 1 December 31, 2015 Calculation Method: Meets or exceeds benchmark Any changes to the criteria are made by and through the appropriate MCPIPA committee(s) approval. Adequate notice is given to the membership prior to implementation. This is a collaborative arrangement with RMHP and MCPIPA. Assessment process: 1Q 2015 Conduct Self-Assessment Each physician conducts a self-assessment on his/her referrals. MCPIPA provides a Scoring Tool to perform a self-assessment on ten (10) referrals received from other physicians from January 1 through March 31. This self-assessment identifies opportunities for improving responses to referring physicians. The Statement of Improvement form provided by MCPIPA facilitates goal-setting for improvement based on the results of self-assessments. The goal must reflect a measurable change. For example, ensure that the specific co-management plan is identified on 80% of the responses to the referring physician. Submit to MCPIPA: The completed Scoring Tool and Statement of Improvement Tool for each of the ten (10) referrals. Due Date: April 15, 2015 2Q2015 Evaluation for Improvement Each physician conducts a second self-assessment on his/her referrals received during the time frame April 1 through June 30. MCPIPA provides the Scoring Tool and for a self-assessment on ten (10) referrals to determine if improvement has occurred based on the stated goal from 1Q2015. Compare the results from 2Q2015 to the goal identified in 1Q2015. Submit to MCPIPA: The completed Scoring Tool and Statement of Improvement with second quarter results for each of the ten (10) referrals. Due Date: July 15, 2015 3Q 2015 Peer Review Each physician asks a fellow physician to review consult notes on five (5) referrals received July 1 through September 30, 2015. When possible, physicians seek consult from a physician in the same specialty as the asking physician. This may mean requesting that a practice partner perform the peer review. The reviewing physician uses the Scoring Tool to provide feedback and identify any opportunities for improvement. Submit to MCPIPA: The completed Scoring Tool for each of the five (5) referrals which includes feedback from the reviewing physician. Due Date: October 15, 2015 4Q 2015 Referring Physician Review Each physician asks the referring physician to review consult notes on five (5) referrals received October 1 through December 31, 2015. When sending the consult note to the referring physician include the Scoring Tool and request that the referring physician immediately review the consult response to his/her referral. The referring physician uses the Scoring Tool to provide feedback to the consulting physician and identify any opportunities for improvement. The referring physician returns the Scoring Tool to the consulting physician in a timely manner that allows the consulting physician to meet the due date for submission to the IPA. Submit to MCPIPA: The completed Scoring Tool for each of the five (5) referrals which includes feedback from the referring physician. Due Date: January 15, 2016

Referral Measure Exceptions: Pathologists are monitored quarterly on obtaining second opinions. At least 90% of the pathology cases are to be sent out for second opinions. The original diagnosis submitted for a second opinion is to be in general agreement with the pathologist who is rendering the second opinion. To be in general agreement, the diagnoses of the pathologist submitting the opinion should be within a similar diagnostic category as the opinion of the pathologist rendering the second opinion. This quality measure provides a good way to assess how the original pathologist s diagnoses compare to peers in pathology. Anesthesiologists measure is based on proper documentation in the chart of the post-op patient visit based on CMS guidelines. Chart documentation must be completed within 48 hours of a procedure using anesthesia. Neonatologists are monitored quarterly on: The physician is to send timely communication of discharge summary to the patients medical home. The goal for the communication is within 24 hours of discharge. The measure is tracked by NICU staff. The denominator is the number of NICU patient during the quarter. The numerator is the number of discharge summaries shared within 24 hours of discharge to home. The ratio must meet the standard set by MCPIPA. Neonatologists are to facilitate the patients scheduling of follow-up appointment with a pediatrician or PCP. Hospitalists are monitored quarterly on hospital discharges: The physician is to send timely communication of discharge summary to the patients medical home. The goal is within 24 hours of discharge. The measure is tracked by Hospitalists staff. The denominator is the number of in-patients during the quarter. The numerator is number of discharge summaries shared within 24 hours of discharge. The ratio must meet the standard set by MCPIPA. Hospitalists are to facilitate timely communication of medication reconciliation at time of discharge. The measure is tracked by Hospitalists staff. The denominator is the number of in-patients during the quarter. The numerator is the number of medication reconciliations shared within 24 hours of discharge. The ratio must meet the standard set by MCPIPA.

SCORING TOOL 1Q2015, 2Q2015, 3Q2015 and 4Q2015 Specialty Physician Name of Physician being Reviewed: Name of Reviewing Physician: Date: Circle quarter covered by this tool: 1Q 2Q 3Q 4Q Indicator of Patient Being Reviewed: (Please de-identify chart under review when submitting this form to MCPIPA; use number rather than patient name) Use the following criteria to perform assessments as required for each quarter in 2015. 1. Confirm receipt of the referral by sending date and time of appointment to referring clinician. Date referral received Date of appointment Date Referring Physician was notified of appointment time 2. In your opinion, did the consulting physician adequately respond to the referring physician s clinical question(s) and the consult note addresses the reason for referral? For example did the summary or synopsis include some thought process that helped determine the treatment plan? 3. Diagnosis: Did the consulting physician s consult note (check those that apply): Confirm the existing diagnosis Indicate a new or changed diagnosis Include ruled out or differential diagnosis 4. Did the consulting physician include (check those that apply) : A plan of care A treatment plan Any patient education A secondary referral Other 5. Did the consulting physician s notes: Clearly state co-management and responsibilities Indicate any recommended services or actions to be done by the Primary Care Physician Indicate who is responsible for follow-up, continued care, or co-management

STATEMENT OF IMPROVEMENT 1Q2015: Due April 15, 2015 State your goal for improvement based on the results of your selfassessments. The goal should reflect a measurable change. For example, ensure that the co-management is identified on 80% of my responses to the referring physician. 1Q2015 Baseline Measure: 2Q2015: Due July 15, 2015 Use the provided Scoring Tool to perform a self-assessment on ten (10) referrals to determine if improvement has occurred based on your goal from 1Q2015, stated above. Compare your results from 2Q2015 to the goal identified in 1Q2015. Knowing those results, what changes will you make now? 2Q2015 Stated Improvement: Physician Name: Practice Name: Date:

A Quick Review for 2015 Referral Measure Specialty Physicians 1Q 2015: Self-Assessment Conduct Self-Assessment on ten (10) referrals received during the time frame January 1 to March 31 and review opportunities for improvement in your response to the referring physician. After reviewing your self-assessment scoring, use the Statement of Improvement form to state your goal for improvement. Submit the Statement of Improvement and the Scoring Tool for each of the ten (10) referrals to MCPIPA by April 15, 2015. 2Q2015 Evaluation for Improvement Use the provided Scoring Tool to perform a self-assessment on ten (10) referrals during the time frame April 1 through June 30. Use the results of the Scoring Tool to determine if improvement has occurred based on your stated goal from 1Q2015. Submit your Statement of Improvement with second quarter results and the Scoring Tool for each of the ten (10) referrals to MCPIPA by July 15, 2015. 3Q 2015 Peer Review A fellow physician will review your consult notes on five (5) referrals received during the time frame July 1 through September 30. The reviewing physician will use the Scoring Tool for each of the five (5) referrals to provide feedback and identify any opportunities for improvement. Submit the Scoring Tool for each of the five (5) referrals which includes feedback from the reviewing physician to MCPIPA by October 15, 2015. 4Q 2015 Referring Physician Review The referring physician will review your consult notes on five (5) referrals received during the time frame October 1 through December 31 and use the Scoring Tool to provide feedback to the consulting physician. Submit the Scoring Tool for each of the five (5) referrals which includes feedback from the referring physician to MCPIPA by January 15, 2016.