HEDIS Pay for Performance (P4P) Audits Quality Measurement By Expert Auditors

What is Healthcare Pay for Performance (P4P)?
Healthcare Pay for Performance (P4P) programs reward hospitals, physician practices and other providers with both financial and non-financial incentives based on performance on select measures. These performance measures can cover various aspects of healthcare delivery: clinical quality and safety, efficiency, patient experience and health information technology adoption. Sponsors of P4P programs typically include government agencies, health insurance plans, employers, healthcare providers, and a variety of coalitions.

I want to self-report my California P4P data. Do I need an audit?
Yes, in order to self-report your physician organization data, you need to have an audit conducted by an NCQA -certified licensed organization, like us. The California P4P program is the largest non-governmental physician incentive program in the United States. Founded in 2001, it is managed by the Integrated Healthcare Association (IHA) on behalf of eight health plans representing well over 10 million insured persons.

An audit seems time consuming and expensive. Is it worth it?
The audit is not as difficult as you may believe. We have 15 years of experience auditing HEDIS and P4P data – we can help you. We specialize in assisting physician organizations new to the P4P process self-report their data. We work with your PO to set up the process so you know exactly what deliverable and deadlines are required.

What are the components of an audit?
The P4P audit begins with a kickoff meeting to Health to review the process, schedule, and designate roles and responsibilities. Next is the P4P ROADMAP. Your PO answers questions to baseline information the auditor uses to assess the conformance to specifications. We then review the program code your PO uses to produce the P4P clinical measures. We will also conduct an onsite visit to observe your systems and processes. We will ask you to produce a series of queries which help validate your results. One of the most important steps is our review of the P4P dataset. We validate your results, benchmarking them to other self-reported groups and comparing the year-over-year results. The audit culminates with a Final Audit Report, summarizing the audit methodology and findings.

Why use our audit firm?
Over the last 5 years, DTS Group audited 2/3 of the Top Overall Physician Organizations as ranked by IHA. We are proud of our ongoing relationships with these organizations and their accomplishments speak for themselves. DTS Group has a 100% success rate in helping POs successfully complete the P4P self-reporting audit process. We can do the same for you.