Participating Physician Group (PPG) Performance Scorecard
As the health care industry in California continues to demand increased performance and value, Health Net has improved our delegation program tools to include an enhanced PPG Performance Scorecard to evaluate PPGs in seven performance areas (PDF). Delegated PPGs are reviewed for performance measures including grievances, contractual financial requirements, delegated medical management, service and quality (see Provider Oversight). The PPG scorecard brings these together in a 360-degree view of performance through an executive dashboard format, with the goal of helping ensure that delegated PPGs are meeting or exceeding standards. The resulting performance management process is governed by the Health Net Delegation Oversight Committee.
The PPG Performance Scorecard is used to:
- Ensure transparency in performance.
- Jointly identify opportunities to improve performance and commit to developing performance improvement plans that are regularly reviewed at joint operation meetings (JOMs) and regular meetings.
- Ensure performance exceeds minimum performance standards.
- Serve as a catalyst for corrective action and improvement plans.
- Align performance to performance standards, penalties and rewards outlined in PPG contracts.
PPGs will receive individualized scorecard results electronically on a quarterly basis via JOMs. Results, opportunities and actions are reviewed in JOMs and workgroups for PPGs with minimum membership thresholds.
PPG performance is measured in seven key performance areas (PDF) including quality, delegation oversight utilization management (UM), delegation oversight claims, risk adjustment, financial solvency, network and encounters. Multiple measures are compiled and calculated by performance area. Findings are weighted by membership to form the performance score, defined through the following scale:
- 80% or greater: Performing – meeting/exceeding performance targets.
- 50-79%: Monitoring – inconsistently meeting performance targets.
- Less than 50%: Below standard – consistently below performance targets.
Continued low performance may result in a corrective action plan (CAP), with expectation of improvement within a specified time-period. If performance does not improve as expected and/or as agreed, an escalation process may be activated. If necessary, formal action may be taken by Health Net’s Delegation Oversight Committee, which may include, but is not limited to, the following:
- Request for formal corrective action.
- A reduction in capitation.
- A freeze on enrollment.
- Revocation of delegation.
- Contract termination.
All action taken by the Delegation Oversight Committee is subject to the terms of the PPG contract.