The following frequently asked questions (FAQ) were developed to provide more detailed information about our new value-based program: Mental Health Incentive Program (MHIP). This FAQ will be updated as new information becomes available.
1. When did the MHIP begin?
Effective January 1, 2024, Independence Blue Cross (IBX) introduced a new Mental Health Incentive Program (MHIP). The MHIP is comprised of two separate and distinct programs utilizing quality metrics for:
- Mental health outpatient/professional practices
- Mental health inpatient facilities
Note: The remainder of these FAQs pertain to the mental health outpatient/professional program. For eligible facilities, dedicated assistance is provided and supported by quarterly meetings with our Behavioral Health team.
2. Who is eligible for the mental health outpatient/professional program (MH-OP)?
Eligible practices must be:
- Located in the following Pennsylvania nine counties: Berks, Bucks, Chester, Delaware, Lancaster, Lehigh, Montgomery, Northampton, or Philadelphia.
- Participating in IBX’s behavioral health network for the entire measurement period.
- One of the following specialties or a multi-specialty with one of the following service providers: Psychology, Social Work, CRN Clinical Nurse Specialist, Addiction Medicine, Master’s Level Therapist, Addiction Psychiatry, Psychiatry, Licensed Professional Counselor and/or Clinical Social Work.
- Billing for the following services: Psychotherapy/Talk Therapy and/or E&M codes supporting Medication Management.
3. Are there membership requirements?
- A practice must have at least ten attributed members on average each month over the course of the measurement year.
- These members must be enrolled in an IBX health plan (Keystone Health Plan East HMO or POS, Personal Choice® PPO, or Medicare Advantage HMO, HMO-POS, or PPO).
4. Am I automatically in the program if I meet the above requirements?
Yes, your practice is automatically entered into the program if you meet the specific provider eligibility and membership requirements identified above.
5. Does this affect my fee schedule/contract arrangement with IBX?
No, this program does not affect your fee schedule arrangement/contract with IBX. The MHIP incentive program is separate from your standard fee schedule arrangement. If you qualify and meet the measures for the program, when evaluated during the measurement year, your practice will be paid in addition to your standard reimbursement.
6. What will I be measured on?
The MH-OP program measures your performance in the following areas:
- Accepting New Patients
- Retaining New Patients
- Average Visits Per Episode
- Mental Health Emergency Department Visits per/1000
- Mental Health Admissions per/1000
- Follow up after Hospitalization for Mental Illness within seven days
- Follow up after Hospitalization for Mental Illness within 30 days
7. What is the reimbursement opportunity available to me?
Each incentive within the MH-OP program is tied to a per attributed member per year (PMPY) reimbursement based on the practice meeting a specific target. Review the MHIP guide for the opportunity available for each measure.
8. How can I learn more about the MHIP?
A detailed program guide can be found on the PEAR Help Center. Once logged in, select Value-Based Programs under Analytics & Reporting. Then, locate the Mental Health Incentive Program (MHIP) guide – IBX.
9. How was the MHIP introduced to providers?
Targeted emails were sent to participating behavioral health providers:
- Program introduction – 12/6/2023
- MHIP guide availability – 2/19/2024
Additional communications about the program will be sent throughout the year.
10. Where and when will practice results be shared?
The following is the schedule of practice reports:
- Mini Preliminary Report. Available in the 2nd quarter of the measurement year. This report provides a preliminary look at your practice’s performance in the “accepting new patients” measure.
- Interim Report. Available in the 3rd quarter of the measurement year. This report provides a preliminary look at your practice’s performance in most of the program’s measures.
- Final Report. This report will be available to practices at the time payment is made to your practice. It provides your final performance in the program’s measures. The report contains a summary of earned incentives and incentive-level supporting details.
Reports will be available in the PEAR Analytics & Reporting application. Select Output Manager from the top navigation bar.
11. When will I be reimbursed?
Practices will be reimbursed after the measurement year is over, usually around the 3rd quarter. For example, measurement year 2024 will be paid out in the summer of 2025.
12. What if I have questions about the program?
For additional questions related to the MHIP, please email us at mhincentiveprogram@ibx.com.