Skip to Content

Provider Manual

Potentially Preventable Readmission (PPR) program

Last Updated on October 16, 2018
  • DHS has launched new BadgerCare Plus HMO quality programs for the 2018-2019 Contract Year including the Potentially Preventable Readmission Incentive Program. The goal of the program is to reduce potentially preventable readmissions for Wisconsin Medicaid members, increase positive patient outcomes and improve lives. Objectives relate to improved discharge planning, better coordination of care across sites of service and other improvements in the delivery of care.
  • The state is using a tiered improvement model to award incentives to HMOs. Baseline calculations for measurement in 2018 will be FFY 2016 data. For 2018, Security Health Plan falls into Tier 3. Starting Jan. 1, 2018, DHS has implemented a 5% withhold on inpatient fee-for-service claims. This withhold is applied to claims for those providers who qualify for the PPR quality measure. More information can be found under the Wisconsin Medicare Hospital Quality Program section here:  ForwardHealth Resources for Hospital Providers. General PPR information that applies to all programs is also included in this section and includes Navigant’s PPR Manual, example reports and PPR Chain examples.
  • Navigant, a vendor of the State, will calculate and share PPR results using 3M PPR software. These reports will be distributed to HMOs quarterly. Security Health Plan will share provider-specific results with hospitals after that time.

Table: PPR Reduction Targets

Proportion of Potential Incentive Share that is earned by the HMO

Baseline Tier (based on ABR)

Tier 1 - High performance HMOs

Tier 2 - Middle performance HMOs

Tier 3 - Low performance HMOs

1.00

5% or more

7% or more

10% or more

0.75

3% to 4.9%

4% to 6.9%

7% to 9.9%

0.50

1% to 2.9%

2% to 3.9%

4% to 6.9%

0.25

0.25% to 0.9%

0.5% to 1.9%

1.5% to 3.9%

  • If Security Health Plan earns an incentive based on the above model, it will share incentive dollars with network hospitals using a similar model for those hospitals with more than 50 qualifying admissions.  The more admissions a facility has, the higher the possible return, depending on performance.