​Update on upcoming changes to our value-based incentive programs

June 24, 2020

As previously communicated in a Partners in Health Update article, Independence introduced the following four goals driving changes to the QIPS program:

  • 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 Program.
  • Assist practices transitioning to value-based care by rewarding incremental improvement.
  • Financially support practices demonstrating a commitment to proactively caring for our members.

For measurement year 2020, we introduced the first two goals by consolidating the QIPS, PQIP, and PCAM programs and increasing the provider earning opportunities available with Medicare gap closures.

Changes for pediatric practices

The role of pediatric practices in value-based care is essential. As we evaluated the changes to the QIPS program, we knew that the current metrics used to evaluate high-quality, cost-effective care did not necessarily translate to our primary care physicians (PCP) with a pediatric population. Therefore, in measurement year 2021, we are offering a new component of the QIPS program designed specifically for pediatricians.

Independence’s vision for the new pediatric component of the QIPS program for measurement year 2021 is focused on the following goals:

  • Providing relevant quality and cost-effective metrics that reward exceptional performance to pediatric and adolescent populations.
  • Improving outcomes by offering incentives to practices for keeping members healthy and increasing access to care while reducing unnecessary emergency room/department (ED) and urgent care visits.

Measurement year 2021 changes

To complete our vision, as well as introduce the new pediatric component, we will implement the remaining goals for measurement year 2021 as outlined below.

  • New: Participation requirement (All PCPs). Starting in the fourth quarter of 2020, practices that wish to participate in the QIPS program for measurement year 2021 must elect to participate in the program through IndexProTM.
  • New: Improvement-based incentive (Family practice/Internal medicine only). A new incentive will be introduced to practices that did not perform at the highest level but have shown notable quality improvement from the prior measurement year.
  • New: Engagement incentive (Family practice/Internal medicine only). Practices that did not perform at the highest level will be eligible for an incentive if they work with Independence’s population health specialists and meet specific engagement criteria.
  • New: Access to Care incentive (Pediatrics only). The QIPS program will continue to drive quality and cost-effective access to care with a new target-based ED-Urgent Care utilization measure.
  • Update: QPM score program ranking system (All PCPs). The Quality Performance Measure (QPM) score program will be moving from a percentile ranking methodology to a measure-based target system.
  • Cost and care efficiency incentives. The QIPS program will continue to drive quality and cost-effective care with existing programs such as:
    • Total Cost Efficiency (All PCPs)
    • Medication Compliance (Family practice/Internal medicine only) and Pharmacy Cost (All PCPs)
    • ED Utilization (Family practice/Internal medicine only)

Details surrounding the participation requirement will be announced in August 2020. However, step one is to ensure that your practice is registered to use the Provider Engagement Analytics and Reporting (PEAR) portal.

If your practice has not registered for the PEAR portal, please review the registration instructions outlined in the PEAR portal section. Once you have registered for the PEAR portal, you can review the available training resources.

Learn more

We thank you for your continued commitment to providing high quality health care to our members, your patients.

If you have any questions regarding the information in this article, please send an email to Jennifer Dombrowski.

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