Independence is working on a two-year plan to improve our existing value-based programs – the Quality Incentive Payment System (QIPS) program, Preventive and Quality Improvement Program (PQIP), and Primary Care Advancement Model (PCAM) – for participating primary care physicians (PCP) and those providers who also participate with Tandigm Health.

Our vision

Over the next two years, Independence will focus on these four main goals:

• Simplify and consolidate the current QIPS, PQIP, and PCAM programs into one single program.
• Better align the new program with Medicare’s Five-Star Quality Rating System.
• Assist practices transitioning to value-based care by rewarding incremental improvement.
• Financially support practices demonstrating a commitment to proactively caring for our members.

These changes are part of a broader program to improve the working relationship between PCPs and Independence to continue to refine the support given to PCPs in improving the health of our members. 

Measurement year 2020

For measurement year 2020, Independence will implement the following changes that focus on delivering the first two goals:

• One program. One manual. As the base of our existing programs is similar, we have incorporated the various aspects of QIPS, PQIP, and PCAM into one consolidated program: QIPS program, which will be reflected in our QIPS Program Manual – Measurement Year 2020. Providers will be measured and scored based on their total combined membership population (commercial and Medicare Advantage HMO, POS, and PPO and National BlueCard^® PPO) instead of separately. We also updated the membership threshold requirements for certain incentives of the QIPS program to reflect combined numbers. All performance payments and tiering structures have been consolidated.
• Enhanced Medicare Advantage incentives. In an effort to acknowledge the work and dedication to close gaps in care for our Medicare Advantage members, we have increased the weight calculated for these members, thus increasing the earnings opportunity.

In addition, the Focus Measures for measurement year 2020 will include:

• cancer screenings (breast, colorectal, and cervical)
• diabetic care composite (diabetic eye exam, HbA1c control <8, and diabetic nephropathy exam)
• statin therapy composite (statin fills for patients with cardiovascular disease and/or diabetes)

Based on these changes to the Focus Measures, Independence will reallocate the Focus Measure incentives for pediatrics to the overall Quality Performance Measure score program incentive payment.

Measurement year 2021

Our second phase of program changes will be implemented for measurement year 2021 and will focus on the two remaining goals. We will reward improvements in each quality measure and continue to assess and support engagement in population health management efforts for your patients, our members.

More information regarding the changes for measurement year 2021 will be announced in the first quarter of 2020.

Learn more

Please review the chart that provides a high-level overview of the changes made from measurement year 2019 to measurement year 2020. In addition, PCPs should review the new QIPS Program Manual – Measurement year 2020 in its entirety to become familiar with the changes. The manual will be available on the Independence Plan Central page of the NaviNet^® web portal (NaviNet Open) in the Current Publications section under Value-Based Program Manuals. A message will be posted on Independence Plan Central once available.

If you have questions about the phased approach, please contact Jennifer Dombrowski at Jennifer.Dombrowski@ibx.com.

If you have any clinical questions, please contact your Network Medical Director.

NaviNet^® is a registered trademark of NantHealth, an independent company.