Clinical Measures - PPMSI



Pay for Performance (aka: Quality Measures) Overview

In January of 2002, The Integrated Health Association (IHA) launched the Pay For Performance (P4P) initiative, a California statewide effort to use standard measures to evaluate the performance of contracted physician organizations. The goals of the program is to develop a common set of measures and publicly report scores for those measures for California Physician organizations and to provider health plans with the information they need for rewarding physician organizations financially based on performance.

Reminder: The Measurement Year is from January 1 to December 31

Clinical Measures:

• Childhood Immunizations Status (CIS) 24- Month Continuous Enrolment

The percentage of enrolled children two years of age that were identified as having completed the following antigen series by their second birthday.

4 DTaP/DT 3 Hepatitis B

3 H Influenza type B 1 MMR

1 Chicken pox vaccine 3 IPV

4 pneumococcal conjugate vaccines

• Appropriate Treatment for Children with Upper Respiratory Infection (URI)

The percentage of children 3 months- 18 years of age who were given a diagnosis of upper respiratory infection (URI) and were NOT dispensed an antibiotic prescription on or 3 days after the episode date.

• Breast Cancer Screening (BCS)

The percentage of Women 42-69 years of age who had a mammogram to screen for breast cancer during the measurement year or year prior to the measurement year.

• Cervical Cancer Screening (CVS)

The percentage of Women 18-64 years of age who received one or more Pap during the measurement year or the two years prior to the measurement year

• Chlamydia Screening in Women (CHL)

The percentage of women 16-25 years of age who were identified as sexually active and who had at least one test for Chlamydia during the measurement year.

• Cholesterol Management for Patients with Cardiovascular conditions (CMC)

The percentage of members 18-75 years of age who, from January 1 through November1 of the year prior to the measurement year, were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1- November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year (January 1 to deceber31) and the year prior to the measurement year.

LDL-C Screening Performed

LDL _C Control ( ................
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