2010-06-07_(2).pdf - 19318.8K - BridgeportCT.gov

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CIGNA HealthCare Performance Guarantee Agreement Customer Bridgeport City BOE Effective Date July 1 2010 Account Number s involved in Performance Guarantee s 3213172 IIr CIGNA EXHIBIT B4 CLINICAL 1 Additional Definitions 11 Baseline Period Means the twelve 12 month incurred period immediately prior to effective date ofthepertinent Disease Management Program Connecticut General reserves the right to re establish the baseline period if it is deemed to be too historical 1 2 Case Management Program Connecticut General case management or utilization management program including complex specialty and catastrophic case management and utilization management programs 13 Client Specific Connecticut General s performance is measured as to Employer s Participants not the CIGNA BookofBusiness 14 Claim Costs for Client Specific Means all fee for service and fee for service equivalents for capitated encounter data health care costs including all pharmacy costs incurred under Employer s applicable Plan s for Covered Services provided Participants during the applicable measurement period i e Baseline Period or Guarantee Period capped at 100 000 per Participant Claims Costs do not include any Participant co payments coinsurance or deductible amounts or any Well A ware Program charges paid by the Employer For purposes ofthis definition a cost is incurred on the datethat a Covered Service is provided to a Participant not the date the Plan pays the cost 15 Core 5 Well Aware The Core 5 Well Aware programs are Asthma Disease Management Program Chronic Obstructive Pulmonary Disease COP D Disease Management Program Diabetes Disease Management Program Heart Disease Management Program Low Back Pain Disease Management 1 6 Covered Services for Client Specific Means health care including pharmacy services and or supplies that are covered under Employer s applicable Plans 1 7 Disease ManagementMaximum The maximum Payment Amount that applies ifnone ofthe Disease Management Guarantees are met during the Guarantee Period The exposure is determined on a pro rata basis for this measure For example if the Guarantee Period results are 90 ofthe target results then only 10 ofthe fees at risk will be paid or credited to Employer 1 8 Documented Care Plan A documented plan for a complex catastrophic and specialty intensilty case management case where there is documented verbal consent from the Plan PElrticipant for case management services and where the plan at aminimum identifies one 1 short term goal oneI long term goal and one 1 exit goal 1 9 ETG Stands for Episode Treatment Group a methodology developed by Symmetry Health and used for measuring compliance with the Pharmacy guarantees 1l0 HEDIS Measure Rotation Shall be defmed as Connecticut General s use of the audited and reportable rate from the prior year s data collection in lieu of collecting the measure for the Guarantee Period based on NCQA approved methodology 1 II Medical Management Full Program Means the full array ofConnecticut OS 28 2010 2010 Performance Guarantee Page 22
CIGNA HealthCare Performance Guarantee Agreement Customer Bridgeport City BOE Effective Date July 1 2010 Account Numbers involved in Performance Guarantee s 3213172 II CIGNA GeneraVCIGNA s medical management servicesi e prior authorization of specialty care pre certification of inpatient admissions continued stay review ofin patient care and case management 1 12 NCQA Quality Compass National Average Calculated by the National Committee for Quality Assurance from a pool of400 public and non public reporting health plan products 1 13 Participant Means the Plan Participants enrolled in the specific Well Aware program For purposes ofDisease Management programs there are Asthma Participants Cardiac Participants COPD Participants Diabetes Participants and LBP Participants Disease management Participants a have been diagnosed as having one ofthe five targeted chronic diseases and have been identified as such by the specific disease identifying methodology or their treating physician b their diagnosis has been made known to Connecticut General c they have not voluntarily opted out ofthe disease specific Well A ware Program and d they are not a participant in another Well Aware Program for another chronic disease 1 14 PDPPM Costs For Client Specific measures stands for Per Disease Participant Per Month costs and means the Claims Costs for the Participants for a given period oftime ie the Guarantee Period or the Baseline Period The PDPPM Costs for the Baseline Period are determined by Connecticut General following a baseline analysis using Employer s Medical Management Claims Set for the Baseline Period Employer s Medical Management Claims Set means themedical and prescription drug claim history with respect to the Disease Management Programs associated with the Performance Guarantees identified in Exhibit A 1 15 ROI Return on Investment measures dollars saved by aspecified program against dollars spent by Employer on that specified program 1 16 Savings Target Measures claim dollars saved by a specific program See specific measurement methodology in applicable Exhibit B for each Performance Guarantee with a Savings Target 2 Additional Conditions Precedent 2 1 Connecticut General shall not be obligated to provide the Client Specific Clinical Perform mce Guarantees if any one or more ofthe following occurs 2 1 1 The number ofEmployees enrolled on the Effective D lte is less than 90 or greater than 110 ofthe Population Projected 2 1 2 There is a 20 or greater turnover in Plan Participants during the Term 2 13 Less than 70 ofall the Plan Participants contact information provided to Connecticut General by Employer or its designated agent is accurate as rea sonably determined by Connecticut General 2 2 For all Clinical Performance Guarantees Employer must have a minimum of 500 Employees in the Plan administered by Connecticut General for the entire Term ofthis Agreement 23 Client s disease prevalence is not below CIGNA book average by more than 5 24 Client s medica and pharmaceutical cost PDMPM is not below CIGNA book averageby more than 10 OS 28 20 I 0 20I0 Performance Guarantee Page 23
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AGENDA CITY COUNCIL MEETING MONDAY
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CITY COUNCIL MEETING Monday June 7
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73 09 Miscellaneous Matters Committ
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COUNCIL MEMBER BAKER MOVED TO WAIVE
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ADJOURNMENT COUNCIL MEMBER CURWEN M
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DRAFT CHARLES FEREIRA 235 CHURCH ST
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SEVENTEEN THOUSAND FIVE HUNDRED DOL
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IN VIEW OF THE FOREGOING We the und
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BILL FINCH Mayor CITY OF BRIDGEPORT
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B11L of 199r62 fO tl40 1994 02 1082
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1999 04226182 DAY DENEISE G 5 26 20
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2002 02 4924167 BANK LOCK SER vICE
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2003 02 6807922 SANTOS JEWELERS 4 2
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2004 02 6095256 SANTIAGO AUTO SALES
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2010-06-07_(2).pdf - 19318.8K - BridgeportCT.gov

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