MCE Quality Based or Value Based Incentive Programs MDwise

MCE Quality Based or Value Based Incentive Programs HEDIS Follow Up After Hospitalization (FUH) FSSA offers Pay for Outcomes (P4O) opportunities for the health plans. On an annual basis, FSSA establishes benchmarks for a set of quality measures defined in the health plan contract and offers additional payment when the health plans meet established goals. MDwise will evaluate performance rates for all outpatient providers. MDwise will measure provider group performance on the FUH, 7-day performance measure. The number of eligible members in each provider group that are successful in obtaining a follow-up appointment with 7-days, will determine the per member amount awarded.

MCE Quality Based or Value Based Incentive Programs Community Mental Health Center (CMHC) Integrated Workgroup with MDwise 16 CMHCs participating in 2017 Goal: to improve member compliance with HEDIS measures HEDIS measures for 2017 Adolescent Well Care Well Child, Ages 3 - 6 Adult Preventive Care Diabetic Screening for members with schizophrenia or bipolar disorder that are on an antipsychotic

Designed to incentivize members for health-related activities Rewards Program Designed to incentivize members for health-related activities Functions like a traditional rewards program where members accumulate points and “cash” them in Points earned can be monitored and cashed in via Online web portal or by calling Customer Service Points are weighted related to the importance of the activity Rewards to choose from include: At the $10 level (25 points): Subway, AMC and ITunes At the $30 level (50 points): Target, Kroger, Speedway and Walgreens; At the $50 level (75 points): Target, BabysRUs and Kohls At all levels HIP members can opt to put their dollar amounts towards their monthly POWER Account payment for HIP Plus

Activities that earn points Sign up for Member Web Portal (with an email address) Sign up to receive Healthy Indiana Plan monthly statements online through the my MDwise Member Portal Completion of a Health Needs Screener (HNS) Completion of an annual physical exam or well-child visits Getting recommended mammogram screening Getting annual cervical cancer screen Getting recommended prenatal visits Completing a postpartum exam

Activities that earn points (cont’d) Getting necessary Diabetic screening HbA1c Lead screening for children 6-24 months Completing a tobacco cessation program High Risk members maintaining contact with their Care Manager Follow-up appointment after a mental health inpatient hospital stay within 7-days Annual flu shot Dental exams, 2 times each year