UnitedHealthcare’s disciplined approach to payment reform leverages years of experience with incentive-based contracting models.
One component of this overall strategy is the Hospital Performance-Based Compensation (HPBC) program, which provides an incentive to hospitals for quality and efficiency improvements in the delivery of health care affecting the overall health of UnitedHealthcare Commercial members and cost of health care.
Baseline Reports provide facility performance data on all available performance measures. This information is available to view in aggregate for a health system or individually by hospital.
Shows the date range and baseline performance for each performance measure along with each component of the calculation that determined the baseline performance
Presents baseline performance data from the composite score of the third party’s data, including Centers for Medicare & Medicaid Services’ (CMS) Hospital Compare Site
Facilities that are contracted with an HPBC program provision will receive quarterly Performance Reports. This report schedule will include quarterly interim reports as well as a Final Performance Report prior to implementation of the next contract rate adjustment.
The Performance Reports include:
Performance measures negotiated into the contract
Baseline performance including any restatements
Total possible performance points
Facility’s actual performance
Performance points earned to date
Percentage of the performance escalator earned
Detail Data Reports
The following Detail Data Reports provide more specific detail to support the Baseline and Performance Reports in a format that lets you sort the data and execute your own analysis.
Patient Level Detail Report for Claims-Based Performance Measures
Provides Diagnosis Related Group (DRG) or Agency for Healthcare Research and Quality (AHRQ) disease group detail and member claims information. The information provided is confidential and may not be further disclosed without UnitedHealthcare's or the member's (as applicable) prior written consent. Individually identifiable health information is subject to the provisions of the Health Insurance Portability and Accountability Act of 1996, as amended from time to time and may be further subject to one or more state or federal privacy laws. Other information may be proprietary and subject to the confidentiality provisions of the participation agreement between UnitedHealthcare and the facility.
Measurement Summary Report for Quality Performance Measures
Provides information from the third party source and the calculations used to determine a composite baseline performance. The information is considered third-party data. UnitedHealthcare will use the most current data available at the time of each quarterly data capture period.
The HBPC Program currently includes 13 performance measures that fall under three measure categories: Efficiency, Operational and Quality.
Need Help with Your Reports?
If you have any questions about the UnitedHealthcare Hospital Performance Based Compensation program or need additional information or assistance in accessing reports, please contact your Network Management Contract Representative or Provider Advocate.
For assistance with questions regarding report access or site registration, contact the Health Care Measurement Resource Center at 866-270-5588. Representatives are available Monday - Friday from 8 a.m. - 5 p.m. Central Time.