Illinois Paying Doctors Bonuses For Providing Quality Care

The Illinois Department of Healthcare and Family Services (HFS) paid approximately $5 million in incentives to physicians who treated patients enrolled in the state’s Health Connect program – a primary care case management program administered by HFS.

The physicians met or exceeded national performance standards in caring for 1.6 million low-income residents.

"We think it’s an extremely wise investment for the overall future health of Illinois citizens," said Illinois HFS Director Barry Maram.

HFS evaluated the performance of more than 5,000 primary care physicians, focusing on five areas critical for promoting public health: child immunizations, child developmental screenings, asthmamanagement, diabetes management and breast cancer screening.

To qualify for bonuses, physicians must meet or exceed standards established by the Healthcare Effectiveness Data and Information Set (HEDIS).

Under terms of the P4P plan, a qualifying primary care physician could receive multiple bonus payments for multiple measurement areas.

HFS collaborated with Ingenix, a health information and consulting services company and a subsidiary of UnitedHealth Group. Ingenix developed measurements and analyzed physician performance based on claims and immunization data, as well as other demographic information.

Data mining and analysis, conducted using HFS’ Medicaid data warehouse, was implemented by Ingenix to help manage the Illinois Medicaid program, one of the nation’s top 10 public health plans based on the number of beneficiaries.

In diabetes management doctors received an incentive payment of at least $20 for each patient that met the diabetes management criteria. If fewer than 79 percent of Health Connect patients on the doctor’s roster did not have the test, the doctors weren’t paid.

In the other areas, the benchmarks for physician bonus payments in Illinois are:

• Child immunizations: At least 62 percent of enrolled two-year-old children are required to be immunized with the correct combinations of vaccines for childhood diseases.
• Child developmental screenings: At least 35 percent of children are required to be screened by the age of 12 months; 25 percent must receive at least one developmental screening between the ages of 12 months and 24 months; and 20 percent must receive at least one developmental screening between the ages of 24 months and 36 months.
• Asthma management: Nearly 92 percent of patients between the ages of 5 and 9 must be on an appropriate controller medication; 89 percent of patients between the ages of 10 and 17 must be on an appropriate controller medication; and 85 percent of patients between the ages of 18 and 56 must be on an appropriate controller medication.
• Breast cancer screening: At least 49 percent of women between the ages of 40 and 69 must have had a mammogram to screen for breast cancer in the measurement year or the year prior.

Address: Illinois Department of Healthcare and Family Services, 201 South Grand Avenue East, Springfield, IL 62763-0001; (217) 782-1200, www.hfs.illinois.gov.