Common use of PCP Turnover Clause in Contracts

PCP Turnover. A high PCP turnover rate may affect continuity of care and may signal poor management of providers. However, some turnover may be expected when MCPs end contracts with physicians who are not adhering to the MCP’s standard of care. Therefore, this measure is used in conjunction with the children and adult access measures to assess performance in the access category. Measure: The percentage of primary care physicians affiliated with the MCP as of the beginning of the measurement year who were not affiliated with the MCP as of the end of the year. For an MCP which had membership as of February 1, 2006: Prior to the transition to the regional-based approach, MCP performance will be evaluated using an MCP’s statewide result for the counties in which the MCP had membership as of February 1, 2006. The minimum performance standard in the Appendix (2.a) will be applicable to the MCP’s statewide result for the counties in which the MCP had membership as of February 1, 2006. The last reporting year using the MCP’s statewide result for the counties in which the MCP had membership as of February 1, 2006 for performance evaluation is CY 2007; the last reporting year using the MCP’s statewide result for the counties in which the MCP had membership as of February 1, 2006 for P4P(Appendix O) is CY 2008. For any MCP which did not have membership as of February 1, 2006: Performance will be evaluated using a regional-based approach for any active region in which the MCP had membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. ODJFS will use the first full calendar year of data (which may be adjusted based on the number of months of managed care membership). from all MCPs serving an active region to determine a minimum performance standard for that region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. Appendix M

PCP Turnover. A high PCP turnover rate may affect continuity of care and may signal poor management of providers. However, some turnover may be expected when MCPs end contracts with physicians providers who are not adhering to the MCP’s standard of care. Therefore, this measure is used in conjunction with the children and adult access measures to assess performance in the access category. Measure: The percentage of primary care physicians providers affiliated with the MCP as of the beginning of the measurement year who were not affiliated with the MCP as of the end of the year. For an MCP which had membership as of February 1, 2006: Prior to the transition to the regional-based approach, MCP performance will be evaluated using an MCP’s county-based statewide result for the counties in which the MCP had membership as of February 1, 2006. The minimum performance standard in the this Appendix (2.a) will be applicable to the MCP’s county-based statewide result for the counties in which the MCP had membership as of February 1, 2006. The last reporting year using the MCP’s county-based statewide result for the counties in which the MCP had membership as of February 1, 2006 for performance evaluation is CY 2007; the last reporting year using the MCP’s county-based statewide result for the counties in which the MCP had membership as of February 1, 2006 for P4P(Appendix P4P (Appendix O) is CY 2008. For any MCP which did not have membership as of February 1, 2006: Performance will be evaluated using a regional-based statewide approach for any all active region regions and counties (Mahoning and Trumbull) in which the MCP had has membership. Regional-Based Statewide Approach: MCPs will be evaluated by regionstatewide, using results for all regions and counties included (Mahoning and Trumbull) in which the regionMCP has membership. ODJFS will use the first full calendar year of data (which may be adjusted based on the number of months of managed care membership). CY 2007) from all MCPs serving an active region CFC membership as a baseline to determine a statewide minimum performance standard for that regionstandard. CY 2008 will be the first reporting year that MCPs will be held accountable to the statewide performance standards standard for an active regionstatewide reporting, and penalties will be applied for noncompliance. Appendix M.

PCP Turnover. A high PCP turnover rate may affect continuity of care and may signal poor management of providers. However, some turnover may be expected when MCPs end contracts with physicians providers who Appendix M Covered Families and Children (CFC) population Page 12 are not adhering to the MCP’s standard of care. Therefore, this measure is used in conjunction with the children and adult access measures to assess performance in the access category. Measure: The percentage of primary care physicians providers affiliated with the MCP as of the beginning of the measurement year who were not affiliated with the MCP as of the end of the year. For an MCP which had membership as of February 1, 2006: Prior to the transition to the regional-based approach, MCP performance will be evaluated using an MCP’s county-based statewide result for the counties in which the MCP had membership as of February 1, 2006. The minimum performance standard in the this Appendix (2.a) will be applicable to the MCP’s county-based statewide result for the counties in which the MCP had membership as of February 1, 2006. The last reporting year using the MCP’s county-based statewide result for the counties in which the MCP had membership as of February 1, 2006 for performance evaluation is CY 2007; the last reporting year using the MCP’s county-based statewide result for the counties in which the MCP had membership as of February 1, 2006 for P4P(Appendix P4P (Appendix O) is CY 2008. For any MCP which did not have membership as of February 1, 2006: Performance will be evaluated using a regional-based statewide approach for any all active region regions and counties (Mahoning and Trumbull) in which the MCP had has membership. Regional-Based Statewide Approach: MCPs will be evaluated by regionstatewide, using results for all regions and counties included (Mahoning and Trumbull) in which the regionMCP has membership. ODJFS will use the first full calendar year of data (CY 2007 — which may be adjusted based on the number of months of managed care membership). ) from all MCPs serving an active region CFC membership as a baseline to determine a statewide minimum performance standard for that regionstandard. CY 2008 will be the first reporting year that MCPs will be held accountable to the statewide performance standards standard for an active regionstatewide reporting, and penalties will be applied for noncompliance. Appendix M.

PCP Turnover. A high PCP turnover rate may affect continuity of care and may signal poor management of providers. However, some turnover may be expected when MCPs end contracts with physicians providers who are not adhering to the MCP’s standard of care. Therefore, this measure is used in conjunction with the children and adult access measures to assess performance in the access category. Measure: The percentage of primary care physicians providers affiliated with the MCP as of the beginning of the measurement year who were not affiliated with the MCP as of the end of the year. For an MCP which had membership as of February 1February1, 2006: Prior to the transition to the regional-based approach, MCP performance will be evaluated using an MCP’s county-based statewide result for the counties in which the MCP had membership as of February 1, 2006. The minimum performance standard in the this Appendix (2.a) will be applicable to the MCP’s county-based statewide result for the counties in which the MCP had membership as of February 1, 2006. The last reporting year using the MCP’s county-based statewide result for the counties in which the MCP had membership as of February 1, 2006 for performance evaluation is CY 2007; the last reporting year using the MCP’s county-based statewide result for the counties in which the MCP had membership as of February 1, 2006 for P4P(Appendix P4P (Appendix O) is CY 2008. For any MCP which did not have membership as of February 1, 2006: Performance will be evaluated using a regional-based statewide approach for any all active region regions and counties (Mahoning and Trumbull) in which the MCP had has membership. Regional-Based Statewide Approach: MCPs will be evaluated by regionstatewide, using results for all regions and counties included (Mahoning and Trumbull) in which the regionMCP has membership. ODJFS will use the first full calendar year of data (CY 2007 - which may be adjusted based on the number of months of managed care membership). ) from all MCPs serving an active region CFC membership as a baseline to determine a statewide minimum performance standard for that regionstandard. CY 2008 will be the first reporting year that MCPs will be held accountable to the statewide performance standards standard for an active regionstatewide reporting, and penalties will be applied for noncompliance. Appendix M.

PCP Turnover. A high PCP turnover rate may affect continuity of care and may signal poor management of providers. However, some turnover may be expected when MCPs end contracts with physicians who are not adhering to the MCP’s standard of care. Therefore, this measure is used in conjunction with the children and adult access measures to assess performance in the access category. Measure: The percentage of primary care physicians affiliated with the MCP as of the beginning of the measurement year who were not affiliated with the MCP as of the end of the year. For an MCP which had membership as of February 1, 2006: Prior to the transition to the regional-based approach, MCP performance will be evaluated using an MCP’s statewide result for the counties in which the MCP had membership as of February 1, 2006. The minimum performance standard in the this Appendix (2.a) will be applicable to the MCP’s statewide result for the counties in which the MCP had membership as of February 1, 2006. The last reporting year using the MCP’s statewide result for the counties in which the MCP had membership as of February 1, 2006 for performance evaluation is CY 2007; the last reporting year using the MCP’s statewide result for the counties in which the MCP had membership as of February 1, 2006 for P4P(Appendix O) is CY 2008. For any MCP which did not have membership as of February 1, 2006: Performance will be evaluated using a regional-based approach for any active region in which the MCP had membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. ODJFS will use the first full calendar year of data (which may be adjusted based on the number of months of managed care membership). from all MCPs serving an active region to determine a minimum performance standard for that region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. Appendix MReport Period: In order to adhere to the statewide expansion timeline, reporting periods may be adjusted based on the number of months of managed care membership. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report period. For the SFY 2009 contract period, performance will be evaluated using the January - December 2008 report period. County-Based Minimum Performance Standard: A maximum PCP Turnover rate of 18%. Action Required for Noncompliance: MCPs are required to perform a causal analysis of the high PCP turnover rate and assess the impact on timely access to health services, including continuity of care. If access has been reduced or coordination of care affected, then the MCP must develop and implement an action plan to address the findings.

PCP Turnover. A high PCP turnover rate may affect continuity of care and may signal poor management of providers. However, some turnover may be expected when MCPs end contracts with physicians who are not adhering to the MCP’s 's standard of care. Therefore, this measure is used in conjunction with the children and adult access measures to assess performance in the access category. Measure: The percentage of primary care physicians affiliated with the MCP as of the beginning of the measurement year who were not affiliated with the MCP as of the end of the year. For an MCP which had membership as of February 1January J, 2006: Prior to the transition to the regional-based approach, MCP performance will be evaluated using an MCP’s 's statewide result for the counties in which the MCP had membership as of February January 1, . 2006. The minimum performance standard in the Appendix (2.a) will be applicable to the MCP’s 's statewide result for the counties in which the MCP had membership as of February January 1, . 2006. The last reporting year using the MCP’s 's statewide result for the counties in which the MCP had membership as of February January 1, 2006 for performance evaluation is CY 2007; CY2007: the last reporting year using the MCP’s statewide 's statew'ide result for the counties in which the MCP had membership as of February January 1, . 2006 for P4P(Appendix Operformance incentives {Appendix 0) is CY 2008CY2008. For any MCP which did not have membership as of February January 1, . 2006: Performance will w i 11 be evaluated using a regional-based approach for any active region in which the MCP had membership. Regional-Based Approach: MCPs will be evaluated by region, using results for all counties included in the region. ODJFS will use the first full calendar year of data (which may be adjusted based on the number of months of managed care membership). i.e.. CY2007) from all MCPs serving an active region to determine a minimum performance standard for that region. CY 2008 will be the first reporting year that MCPs will be held accountable to the performance standards for an active region, and penalties will be applied for noncompliance. Report Period: For the SFY 2006 contract period, performance will be evaluated using the January -December 2005 report period. For the SFY 2007 contract period, performance will be evaluated using the January - December 2006 report period. For the SFY 2008 contract period, performance will be evaluated using the January - December 2007 report period. Minimum Performance Standard: A maximum PCP Turnover rate of 18%. Action Required/or Noncompliance: MCPs are required to perform a causal analysis of the high PCP turnover rate and assess the impact on timely access to health services, including continuity of Appendix MM care. If access has been reduced or coordination of care affected, then the MCP must develop and implement an action plan to address the findings.