| Updates | Be
sure to close gaps in care for 2025
We want to remind you to submit any documentation required to close care gaps for services rendered in 2025. Documentation must be received by January 15, 2026, to be considered for measurement year (MY) 2025 of the Quality Incentive Payment System (QIPS) program. Please refer to the submission process outlined in the June 18, 2025 email to close gaps in care. Charts will be accepted for these quality measures: - Colorectal Cancer Screening (COL)
- Cervical Cancer Screening (CCS)
- Kidney Health Evaluation (KED)
- Glycemic Status Assessment (GSD)*
- Osteoporosis Management in Women with a fracture (OMW)
*Starting in the 4th quarter. As previously communicated, the feedback process for the Quality Performance Measure (QPM) score program, a component of the QIPS program, has been discontinued. MY 2024 was the final year. For Epic Payer partners, established Epic Payer Platform connections will automatically share clinical encounter-level and supplemental information to Independence Blue Cross via the Clinical Data Exchange upon the appropriate member match. Therefore, we will not accept or review any additional data submitted from an Epic Payer partner. For questions related to the 2025 feedback process, please contact Jennifer.Kennedy@ibx.com.
| 12/15/2025 | | Updates | Top
quality recognition
Independence Blue Cross congratulates these primary care offices for achieving top quality practice recognition in the Quality Performance Measure (QPM) score program, a component of the Quality Incentive Payment System (QIPS) program, for measurement year (MY) 2024. These practices achieved either of the following for MY 2024: - Adult practices. An overall mean performance band of less than or equal to 2.5 (lower is better), had no quality measures in the lowest band (band 5), and at least one quality measure in the highest band (band 1).
- Pediatric practices. An overall performance in the highest band (band 1) in both the vaccination and well-visit composite quality measures.
You can find details of the QPM score program, including the measures scored, in the QIPS Manual – measurement year 2024, which is available on the PEAR Help Center under Analytics & Reporting – Value-Based Programs.
| 10/31/2025 | | Updates | QIPS: Updated targets for MY 2025
We recently adjusted the targets for the Quality Incentive Payment System (QIPS) program for measurement year (MY) 2025. Now that a complete year of 2024 claims data is available, we re-evaluated the targets sets and adjusted them according to the most recent available data.
Please review the updated 2025 QIPS Program Guide on the PEAR Help Center for the adjusted targets, which are your final targets for MY 2025. Note: You must log into the PEAR portal to view the guide.
| 10/27/2025 | | Updates | Deadline
extension: Closing gaps in care in 2025
We sincerely appreciate the dedication of primary care practices and recognize the many demands you face. To support your efforts, we are extending the deadline to close any open gaps in care for 2025 to January 15, 2026. As a reminder, the feedback process for the Quality Performance Measure (QPM) score program, a component of the Quality Incentive Payment System (QIPS) program, has been discontinued. Measurement year (MY) 2024 was the final year. If you have documentation that requires chart submission to close care gaps, it must now be received by January 15, 2026, to be considered for the MY 2025 QIPS program. Please refer to the submission process outlined in the June 18, 2025 email to close gaps in care. Charts will be accepted for these quality measures: - Colorectal Cancer Screening (COL)
- Cervical Cancer Screening (CCS)
- Kidney Health Evaluation (KED)
- Glycemic Status Assessment (GSD)*
- Osteoporosis Management in Women with a fracture (OMW)
*Starting in the 4th quarter. For Epic Payer partners, established Epic Payer Platform connections will automatically share clinical encounter-level and supplemental information to Independence Blue Cross via the Clinical Data Exchange upon the appropriate member match. Therefore, we will not accept or review any additional data submitted from an Epic Payer partner. For questions related to the 2025 feedback process, please contact Jennifer.Kennedy@ibx.com.
| 10/22/2025 | | Updates | MY 2024 QIPS program results
We recently completed our review and calculated the results for the Quality Incentive Payment System (QIPS) program for measurement year (MY) 2024. Payments for MY 2024 were recently processed. You can use the QIPS Payment Roster in PEAR Analytics & Reporting (AR) to view a member-level breakdown of these payments. For help finding the information, please refer to the Accessing QIPS Payment Rosters video in the PEAR Help Center. To access your final report in PEAR AR, select Output Manager at the top of the page, then Published Reports. The report contains your QIPS overall results and your QPM score program performance. We acknowledge that the payments were delayed beyond our expectations. We sincerely appreciate your patience, flexibility, and understanding during this time. Thank you again for your dedication to enhancing the health and wellness of our members, and your patients.
| 10/16/2025 | | Updates | Update for QIPS MY 2024 payments
For providers who participated in the Quality Incentive Payment System (QIPS) program for measurement year (MY) 2024, the final annual payments have been finalized, and we anticipate payments will be made by the week of October 20, 2025. We acknowledge that the payments were delayed beyond our expectations. We sincerely appreciate your patience, flexibility, and understanding during this time while we worked to ensure payment accuracy and integrity.
A message will be posted on this page and on the PEAR portal once the payments and reports are available.
| 10/13/2025 | | Updates | Changes to the QIPS program for measurement year 2026
We value the efforts of all the providers in our network to provide high quality, coordinated care to our members. We want to make sure you are aware of important changes that are being made to the Quality Incentive Payment System (QIPS) program. Starting January 1, 2026, the start of the new measurement year (MY), the QIPS adult program will focus exclusively on independent primary care practices. As a result, adult practices (i.e., family practice/general practice, internal medicine) that are contracted with Independence Blue Cross (IBX) or one of its applicable affiliates through a health system's professional participation agreement will no longer be eligible to participate in the QIPS adult program. All our primary care practices play a vital role in delivering care to our members. Independent primary care practices, however, frequently operate without the robust infrastructure that is available to those practices that participate with IBX through a health system. We're making this change to our QIPS adult program to help bridge that gap. Adult primary care practices contracted with us through a health system remain integral to our network. They will continue to be measured, or have the opportunity to be measured, on quality and cost performance in IBX's contractual value-based programs (e.g., Total Value of Care). Summary of QIPS MY 2026 changes - Eligibility changes. Starting in MY 2026, adult practices (i.e., family practice/general practice, internal medicine) that are contracted with IBX or one of its applicable affiliates through a health system's professional participation agreement are excluded from the QIPS adult program. Eligibility for the QIPS program dedicated to pediatric practices will remain unchanged.
- Retirement of QIPS program opt-in. There is no longer a requirement for practices to opt in to the QIPS program. Practices that meet the eligibility criteria and practice requirements of the program will automatically be entered into the QIPS program for the upcoming measurement year.
- QIPS program guide updates. The QIPS program guide for MY 2026 will be available toward the end of 2025. We will communicate via email, the PEAR portal, and the QIPS Resources page when it becomes available.
Thank you for your continued partnership and commitment to delivering high-quality care. If you have questions or concerns about this change, please email Jennifer Kennedy.
| 10/1/2025 | | Updates | Reminder:
Closing gaps in care in 2025
As a reminder, the feedback process for the Quality Performance Measure (QPM) score program, a component of the Quality Incentive Payment System (QIPS) program, has been discontinued. Measurement year (MY) 2024 was the final year. If you have documentation that requires chart submission to close care gaps, it must be received by December 19, 2025, to be considered for the MY 2025 QIPS program. Please refer to the submission process outlined in the June 18, 2025 email to close gaps in care. Charts will be accepted for these quality measures: - Colorectal Cancer Screening (COL)
- Cervical Cancer Screening (CCS)
- Kidney Health Evaluation (KED)
- Glycemic Status Assessment (GSD)*
- Osteoporosis Management in Women with a fracture (OMW)
*Starting in the 4th quarter. For Epic Payer partners, established Epic Payer Platform connections will automatically share clinical encounter-level and supplemental information to Independence Blue Cross via the Clinical Data Exchange upon the appropriate member match. Therefore, we will not accept or review any additional data submitted from an Epic Payer partner. For questions related to the 2025 feedback process, please contact Jennifer.Kennedy@ibx.com.
| 9/18/2025 | | QIPS MY 2024 payment update
We communicated last month on the Provider Engagement, Analytics & Reporting (PEAR) portal that there would be a delay in MY 2024 QIPS payments to providers eligible for the Quality Incentive Payment System (QIPS) program.
We are working to finalize payments by the end of the month. We will post an update once the payments and reports have been released.
We apologize for the delay and any inconvenience this may cause.
| 9/18/2025 | | Updates | Delay in QIPS payments for MY 2024
Attention! There will be a slight delay in the release of incentive payments to eligible providers for their measurement year (MY) 2024 performance in the Quality Incentive Payment System (QIPS) program. We are working to finalize the payments and publish the QIPS final reports as soon as possible. We will post an update once the payments and reports have been released. We apologize for the delay and any inconvenience this may cause.
| 8/25/2025 | | Updates |
Submit your BlueCard® PPO Host claims to IBX to maximize incentive payments
You have an opportunity to increase the incentive payments earned through our value-based incentive programs – like the Quality Incentive Payment System (QIPS) program – by sending your professional Host claims to Independence Blue Cross (IBX).
Incentive payments are based on the attributed membership on record as of the payment month. To maximize the attribution of National BlueCard® PPO members, practices should submit professional claims to IBX. To get the full benefit of your practice's IBX incentive program, submit all your out-of-area claims directly to IBX.
Through the BlueCard Program, providers can render services to patients who are enrolled in a Blue Cross® and Blue Shield® Plan – other than one offered by IBX – and patients can visit physicians or facilities within the IBX five-county service area (i.e., Bucks, Chester, Delaware, Montgomery, and Philadelphia counties) for treatment.
There are two BlueCard PPO networks within the IBX five-county service area:
- Personal Choice® (IBX's PPO network)
- Premier Blue (Highmark Blue Shield's [Highmark] PPO network)
PPO professional providers
PPO professional providers in the five-county network should submit BlueCard claims to the Plan with which they have a contract. A provider who contracts with both networks can choose to submit to either Highmark or IBX for members not covered by Highmark or IBX. Claims for Highmark or IBX members must be submitted to the Plan that insures the member. Review the full article for examples of scenarios and additional submission rules.
| 7/21/2025 | | Updates | Closing gaps in care in 2025 and beyond
Closing gaps in care is essential to ensuring that our members (your patients) receive the care they need when they need it. By addressing these gaps, we can improve health outcomes, enhance the patient experience, and support timely interventions that prevent conditions from worsening. Together, we can enhance care coordination, expand preventive services, and empower patients, reflecting our commitment to delivering compassionate, high-quality care. Follow these tips to close gaps in care: - Ensure your office staff are using the available reporting in the
Analytics & Reporting application of the Provider Engagement, Analytics & Reporting (PEAR) portal to identify open care gaps (i.e., Attributed Member Snapshot and Gaps in Care report). We recommend running these reports each quarter: March, June, September, and November.
- Review the
Gap Closures Guides for both
Pediatrics and
Adults for measure-specific information related to the clinical quality measures.
- Submit claims in a timely manner leveraging appropriate coding when applicable. Reference the above
Gap Closures Guides for guidance.
- Use PEAR
Comprehensive Visit to submit gap closures for your Medicare Advantage and Affordable Care Act member populations.
If the above steps are followed yet an open care gap remains, please review the
2025 submission process for the measures where feedback is accepted.
For Epic Payer partners, established Epic Payer Platform connections will automatically share clinical encounter-level and supplemental information to Independence Blue Cross via the Clinical Data Exchange upon the appropriate member match. Therefore, we will not accept or review any additional data submitted from an Epic Payer partner.
|
Feedback submissions must be received by December 19, 2025. For questions related to the 2025 feedback process, please contact
Jennifer.Kennedy@ibx.com.
| 6/19/2025 | | Due today! QPM score program electronic feedback
Today, June 2, 2025, is the last day for practices to submit their electronic feedback for the QPM score program for measurement year 2024. If you have not done so and wish to submit feedback, please access the QPM Feedback application from the PEAR portal. Key reminders - By completing feedback, your practice has a chance to improve its final results, which can positively impact your incentive amount.
- Once complete, each eligible form must be attested by an authorized user. Forms that result in the “Reviewed; No action required" status for all of a member's open care gaps do not require attestation.
Note: The physician who rendered the service does not have to be the attesting physician. If you have questions, please email Jennifer Kennedy.
| 6/2/2025 | | Updates | Last week to complete
your QPM score program electronic feedback –
Due June 2
Monday, June 2, 2025, is the deadline to complete electronic feedback for the Quality Performance Measure (QPM) score program for measurement year 2024. Please take time to complete your patient records before the deadline to ensure they are counted for feedback. By completing feedback, your practice has a chance to improve its final results, which can positively impact your incentive amount.
Reminders - A patient record will only count towards feedback when it is marked as Complete. If a record status is Ready to Attest, the information will not be reviewed and counted.
- Use the “Reviewed (No action required)" button to confirm that the member's form was reviewed and there are no specific measures to complete as no service was performed. This option does not require provider attestation.
Note: The physician who rendered the service does not have to be the attesting physician. If you have questions, please email Jennifer Kennedy.
| 5/27/2025 | | Updates | Extended! The deadline to complete your QPM score program electronic feedback is now June 2
To allow more time to complete and submit your feedback, we are extending the deadline to Monday, June 2, 2025, for the Quality Performance Measure (QPM) score program for measurement year 2024. Please take time to complete your patient records before the deadline to ensure they are counted for feedback. By completing feedback, your practice has a chance to improve its final results, which can positively impact your incentive amount. Reminders - A patient record will only count towards feedback when it is marked as Complete. If a record status is Ready to Attest, the information will not be reviewed and counted.
- Use the “Reviewed (No action required)" button to confirm that the member's form was reviewed and there are no specific measures to complete as no service was performed. This option does not require provider attestation.
Note: The physician who rendered the service does not have to be the attesting physician. If you have questions, please email Jennifer Kennedy.
| 5/16/2025 | | Updates | Preliminary reports for the QPM score program now available
The QPM Preliminary score reports are now available for the Quality Performance Measure (QPM) score program for measurement year 2024. Go to PEAR Analytics & Reporting and select Output Manager at the top of the page. The reports are posted under Published Reports. Please keep in mind these reports are not a reflection of final payment or performance. Band levels may change after feedback and additional claims data are taken into consideration. As a reminder, May 23, 2025, is the deadline to complete and attest the QPM feedback forms. If you have questions, please contact Jennifer Kennedy.
| 5/8/2025 | | Updates | The month of May shines a spotlight on Women’s Health We encourage you to view this women’s health flyer that highlights recommended preventive care services for women, including essential visits and screenings. Many of these screenings are also included in the Quality Incentive Payment System (QIPS) program, making it a win-win for both our members and providers.
| 5/8/2025 | | Updates |
Use your PEAR report to identify and close W30 gaps in care To support providers in completing W30 Well Visits and closing W30 gaps in care, Independence Blue Cross (IBX) has developed a report that allows providers to see which of their pediatric patients (our members) need preventive W30 Well Visits or have gaps in clinical care in the first 30 months of life. Available on the Provider Engagement, Analytics & Reporting (PEAR) portal, this report indicates whether your pediatric patients are eligible for a W30 Well Visit, or if they have missed an important wellness visit and need additional support to catch up on immunizations and other key tests, such as lead testing.
Please note: Practices in the Quality Incentive Payment System (QIPS) program are eligible to receive an incentive for closing W30 gaps in care.
We all recognize the importance of well-child visits in early life:
-
Six or more well visits by age 15 months (W15)
-
One or two well visits by age 30 months (W30)
How to access your report:
Sign in to PEAR portal. Select the Analytics & Reporting application.
Go to Report Center.
Click Attributed Member Snapshot, select the practice of interest, and then click
"Select All" under
Select Data Category.
On the right-hand side, click
Submit.
Once the report has completed, go to Output Manager and download the report.
Find the column titled “Well child visits in first 30 months"
“Closed" means the patient is compliant for the measure; “Open" means the patient has a gap for the measure.
If you have questions about accessing your report, please contact PEAR Support at 1-833-444-PEAR (1-833-444-7327). For more information, please contact Joy-Pauline Binns at Joy.Binns@ibx.com.
| 4/28/2025 | | Updates | MY 2024 QPM score program electronic feedback is now live!
The following are available for the QPM score program for measurement year (MY) 2024: - QPM Feedback application. Log in to the Provider Engagement, Analytics & Reporting (PEAR) portal and select the QPM Feedback application. You can review and complete the electronic forms for your patients for whom we do not have a record of receiving the indicated preventive service. Review the Instructions and Definitions section before reviewing and filling out the patient records.
- QPM user guide. The QPM Feedback Application user guide is available in the PEAR Help Center (Analytics & Reporting – Valued-Based Programs) to assist you in navigating the tool and completing the feedback forms.
- QPM Preliminary score report. Preliminary reports will soon be available. To view and download your preliminary report, select the Analytics & Reporting application, and then select Output Manager from the top navigation menu. The report will be posted under Published Reports. We will post a Notification on PEAR once available.
Attestation process
Once complete, each eligible form must be attested by an authorized user. As a reminder, forms that result in the “Reviewed; No action required" status for all of a member's open care gaps, do not require attestation. Note: The physician who rendered the service does not have to be the attesting physician. The deadline to submit feedback is Friday, May 23, 2025. Only records in a 'Completed' status will be evaluated for feedback. If you have any questions, please contact Jennifer Kennedy.
| 4/17/2025 | | Updates | HPV vaccination recommended at age 9 Independence Blue Cross would like to remind you that the American Cancer Society (ACS), ACS National HPV (Human Papillomavirus Vaccines) Vaccination Roundtable, and American Academy of Pediatrics all recommend initiating HPV vaccination at age 9.1 By doing so, you can play a crucial role in protecting your 9-to-12-year-old patients from six types of cancer. Starting the HPV vaccine series at age 9 offers several significant benefits: - More time to complete the vaccine series on time by age 13
- A stronger immune response to the HPV vaccine
- Increased likelihood of vaccinating prior to first HPV exposure
- Fewer questions about sexual activity from parents and guardians
- Fewer requests for only vaccines that are “required" for school
- Fewer shots per visit
- Highly acceptable to systems, providers, and parents
Please review the letter from the Pennsylvania Cancer Coalition, which includes resources to help your practice begin initiating HPV vaccination at age 9, as recommended by the ACS, ACS National HPV Vaccination Roundtable, and American Academy of Pediatrics. We are sharing this information for awareness and recognize that you are the most qualified to determine the best care for your patients (our members).
Thank you for your dedication to caring for your pediatric patients and for joining us in this important initiative to prevent cancer through HPV vaccination. 1 American Academy of Pediatrics: Human Papillomavirus Vaccines
| 4/16/2025 | | Updates |
QPM feedback process begins next week
The feedback process for the Quality Performance Measure (QPM) score program for measurement year (MY) 2024 begins next week. As a reminder, MY 2024 will be the last year of the QPM feedback process. We'll share more information in early summer about gap closure data submissions for MY 2025 and moving forward.
QPM feedback important dates -
April 17, 2025:
- An email will be sent to launch the QPM Feedback application. The QPM feedback user guide will be available in the
PEAR Help Center under Analytics & Reporting – Value-Based Programs.
-
Late April:
- The QPM Preliminary reports will not be available when the QPM feedback process goes live. We anticipate a late April launch and will post an announcement on PEAR once available. The reports will be available to download under
Output Manager in the Analytics & Reporting application of the Provider Engagement, Analytics & Reporting (PEAR) portal.
-
May 23, 2025:
- Last day to attest and submit electronic feedback forms.
Attestation process Although supporting documentation is not required when submitting feedback, forms
must
be attested by an authorized user for the feedback forms to be accepted. However, if a member's form status results in “Reviewed; No action required" for all of their open care gaps, attestation is
not required in this scenario.
Note: The physician who rendered the service does not have to be the attesting physician. If you have not done so already, consult with your PEAR Organization or Location Administrator to review the list of physicians who require attestation access and have them follow these steps to add or remove physicians as needed: - Log in to
PEAR and select
Provider Administration Tool.
- View each physician's PEAR profile by clicking the three dots under the Actions column.
Note for Health Systems or provider groups: Please ensure that the physician who is to attest for each practice is credentialed at each practice location.
- Check to ensure they have a
Clinical role for Analytics & Reporting for each practice and that the user's individual practitioner NPI is entered in their profile (if applicable).
For questions about the feedback process or your attesting physicians, please email us at
feedback@ibx.com.
If you have general questions about the QIPS program, please contact
Jennifer Kennedy.
| 4/11/2025 | | Updates | QIPS program guide for MY 2025
The Quality Incentive Payment System (QIPS) program guide for measurement year (MY) 2025 is now available. You can access the guide in the PEAR Help Center under Analytics & Reporting – Value-Based Programs. Sign-in is required.
An overview of QIPS MY 2025 program changes are provided below in the update posted on December 30, 2024. In addition, be sure to review additional information on each of the Quality Measures for MY 2025.
For more information regarding the QIPS program, please email Jennifer Kennedy. If your question is of a clinical nature, please contact Ellen Riccobene, M.D. or Luz Ramos, M.D.
| 3/25/2025 | | Reference Materials | | 3/24/2025 | | Quality Measures |
Quality Performance Measure (QPM) score program -
NEW!
The Quality Performance Measure (QPM) score program component of QIPS offers incentives for services provided during the measurement year (January through December of the measurement year, unless otherwise noted) for the measures listed below. For additional information, review the
QIPS program guide – measurement year 2025 on the
PEAR Help Center under Analytics & Reporting – Value-Based Programs.
2025 Quality measures
Adult program
Pediatric program -
Well-Visit Composite:
-
Vaccination Composite:
| 3/24/2025 | | Updates | Important updates to the QPM feedback process
Physicians
must attest that the information entered in the electronic feedback forms is accurate to be accepted. A form is not considered complete until a physician completes the attestation. To prepare, review your attesting physicians. Here's how: Consult with your Provider Engagement, Analytics & Reporting (PEAR) Organization or Location Administrator to review the list of physicians who require attestation access. Ask them to follow these steps to add or remove physicians as needed: - Log in to
PEAR and select
Provider Administration Tool.
- View each physician's PEAR profile by clicking the three dots under the Actions column. NOTE for Health Systems or provider groups: Please ensure that the physician who is to attest for each practice is credentialed at
each practice location.
- Check to ensure they have a
Clinical role for Analytics & Reporting for each practice and that the user's individual practitioner NPI is entered in their profile (if applicable).
We ask that you complete your review and make any necessary changes by April 1, 2025.Have questions about your attesting physicians? Email us at
feedback@ibx.com.
MY 2024 feedback timeline
The QPM feedback application will be available in mid-April on the PEAR portal and will be open for one month. Specific dates and more detail will be provided in early April. A user guide explaining how to access, complete, and attest to the feedback forms is available in the PEAR
Help Center. As previously communicated, measurement year (MY) 2024 will be the
final year of the Quality Performance Measure (QPM) feedback process.
Closing care gaps for MY 2025 With the retirement of the QPM feedback program, all open care gaps must be closed within the measurement year to receive credit; there will not be an opportunity to provide additional information after December 31, 2025. In lieu of this change, review these recommendations to identify and close gaps in care during the measurement year: - Ensure your office staff are using all the available reporting in PEAR Analytics & Reporting to identify open care gaps (i.e., Attributed Member Snapshot, Gaps in Care report).
- Review the
Gap Closures Guides for both Pediatrics and Adults for measure-specific information related to the clinical quality measures. The guides are available in the PEAR
Help Center under Value-Based Programs.
- Submit claims in a timely manner leveraging appropriate coding when applicable. Reference the
Gap Closures Guides for guidance.
- For Epic Payer partners, established Epic Payer Platform connections will automatically share clinical encounter-level and supplemental information to Independence Blue Cross (IBX) via the Clinical Data Exchange upon the appropriate member match.
- Use PEAR Comprehensive Visit to submit gap closures for your Medicare Advantage and Affordable Care Act member populations.
Look for more details in the coming months on submitting data when a care gap is knowingly closed yet there is a discrepancy on the status in our records.
Questions For more information about the QIPS program, please email
Jennifer Kennedy. If your question is of a clinical nature, please contact
Ellen Riccobene, M.D. or
Luz Ramos, M.D.
| 3/24/2025 | | Updates | Updates to the QIPS program – MY 2025 A summary of changes to the Quality Incentive Payments System (QIPS) program for measurement year (MY) 2025 was posted below on October 7, 2024. We are sharing a few additional changes that were recently made – see those marked in blue. We are working to finalize the QIPS MY 2025 program guide, which will be published in January 2025. Important update: We notified providers on November 19, 2024, that the Keystone HMO Children's Health Insurance Program (CHIP) product will transition from Keystone Health Plan East, Inc. to its affiliate Vista Health Plan, Inc. (d/b/a Keystone First) on July 1, 2025. Keystone First membership is not included in the QIPS program. For the QIPS program, please keep in mind that membership eligibility requirements do apply, and the program measurement year's payments are based on the participating membership at the time of payment. QIPS MY 2025 – Adult program changes The following incentives/measures will be retired: - Engagement Incentive program – The final payment for those practices eligible in 2024 was in December 2024.
- Improvement Incentive
- Other clinical quality measures (measures within the Quality Performance Measure [QPM] score program). This measure consists of the following HEDIS® measures:
- Osteoporosis management in women who had a fracture
- Avoidance of antibiotic treatments for adults with acute bronchitis
- Persistence of beta blocker treatment after a heart attack
Note: The Well-care visits will become a stand-alone measure.
- Primary Care Visit Measure – this measure correlates to the HEDIS measure Adults' Access to Preventive/Ambulatory Health Services (AAP)
- QPM score program feedback – more information on how to submit feedback in 2025 is detailed below. Note: This change also applies to the Pediatric program.
Updates to measure combinations and new measures addedThe following measures will be assessed independent of each other versus a combination measure: - Diabetic Care. You will have an opportunity to earn incentives on four distinct measures versus one.
- Glycemic Status assessment for patients with diabetes will become two measures, measuring the Commercial population different than the Medicare Advantage population:
- Commercial – Glycemic status assessment for patients with diabetes <8.0 percent
- Medicare Advantage – Glycemic status assessment for patients with diabetes <9.0 percent – NEW for 2025
- Eye Exam
- Kidney Health Evaluation
- Medication Management. You will have an opportunity to earn incentives on six measures versus one. The following are the measures included in this category:
- Commercial – Statin therapy for patients with diabetes (SPD) - Dispensed
- Medicare Advantage – Statin Use in Patients with Diabetes (SUPD) - Adherence – NEW for 2025
- Statin Therapy for Patients with Cardiovascular Disease - Dispensed (SPC)
- Medication Adherence for cholesterol
- Medication Adherence for hypertension
- Medication Adherence for diabetes medications
Retirement of QPM Feedback
The QPM score program feedback process is retiring for MY 2025. This means that all gap closures must be closed in the measurement year; there will not be an opportunity to provide additional information after the measurement year ends. Note: The QPM feedback process will still be available for MY 2024. This will occur in the second quarter of 2025.
How to close gaps in care: - Ensure your office staff are using all the available reporting on PEAR Analytics & Reporting to identify open care gaps (i.e., Attributed Member Snapshot, Gaps in Care report).
- Please use the Gap Closures Guides for both Pediatrics and Adults. The guides are available in the PEAR Help Center under Value-Based Programs. These guides provide measure-specific information related to the clinical quality measures.
- Submit claims in a timely manner leveraging appropriate coding when applicable. Reference the Gap Closure Guides for guidance.
- If you are an Epic Payer partner, established Epic Payer Platform connections will automatically share clinical encounter level and supplemental information to Independence Blue Cross via the Clinical Data Exchange upon the appropriate member match.
- Utilize PEAR Comprehensive Visit to submit gap closures for your Medicare Advantage and Affordable Care Act populations.
- If any of the above are not an option, please use the following:
- Fax line: 215-761-0258. The fax MUST include a cover sheet with the name of the practice submitting the information and the care gaps they are trying to close.
- Use Globalscape to submit your information. If you don't already have an established link, please contact Sheila Burton.
If there are any questions about these changes, please email Jennifer Kennedy. If your question is of a clinical nature, please contact Ellen Riccobene, M.D. or Luz Ramos, M.D.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission. | 12/30/2024 | | Updates | | 10/29/2024 | | Updates | Top quality recognition
Independence Blue Cross congratulates these primary care offices for achieving top quality practice recognition in the Quality Performance Measure (QPM) score program, a component of the Quality Incentive Payment System (QIPS) program, for measurement year (MY) 2023. These practices achieved either of the following for MY 2023: - Adult practices. An overall mean performance band of less than or equal to 2.5 (lower is better), had no quality measures in the lowest band (band 5), and at least one quality measure in the highest band (band 1).
- Pediatric practices. An overall performance in the highest band (band 1) in both the vaccination and well-visit composite quality measures.
You can find details of the QPM score program, including the measures scored, in the QIPS Manual – measurement year 2023, which is available on the PEAR Help Center under Analytics & Reporting – Value-Based Programs.
| 10/14/2024 | | Updates |
QIPS MY 2025 program changes and opt-in process Please take the time to opt in for measurement year (MY) 2025 of the Quality Incentive Payment System (QIPS) program.
The deadline to complete the opt-in process is January 31, 2025. See more details below.
QIPS MY 2025 changes The QIPS program is evaluated throughout the year to ensure it provides high-value programs that deliver quality member experiences and outcomes. Therefore, we would like to highlight some changes to the QIPS program for MY 2025. Details of these changes will be provided in the
QIPS program guide for MY 2025, which will be available towards the end of 2024.
Adult program changes The following incentives/measures will be retired: - Engagement Incentive program – The final payment for those practices eligible in 2024 will be in December 2024. The final quarterly review is being done now and will be applied to the final quarter of this year (October – December 2024).
- Improvement Incentive
- Other clinical quality measures (measures within the Quality Performance Measure [QPM] score program). This measure consists of the following HEDIS® measures:
- Osteoporosis management in women who had a fracture
- Avoidance of antibiotic treatments for adults with acute bronchitis
- Persistence of beta blocker treatment after a heart attack
- Well-care visits (adult practices only)
The following measures will be assessed independent of each other versus combining the measures together into one combination measure: -
Diabetic Care. You will have an opportunity to earn incentives on four distinct measures versus one.
- Glycemic Status assessment for patients with diabetes will become two measures, measuring the Commercial population different than the Medicare Advantage population:
- Commercial – Glycemic status assessment for patients with diabetes <8.0 percent
- Medicare Advantage – Glycemic status assessment for patients with diabetes <9.0 percent
- Eye Exam
- Kidney Health Evaluation
-
Medication Management. You will have an opportunity to earn incentives on six measures versus one. The following are the measures that will make up this category:
- Statin therapy for patients with diabetes (SPD) - Dispensed – Will be measured on the Commercial population.
- Statin Use in Patients with Diabetes (SUPD) - Adherence – Will be measured on the Medicare Advantage population.
- Statin Therapy for Patients with Cardiovascular Disease - Dispensed (SPC)
- Medication Adherence for cholesterol
- Medication Adherence for hypertension
- Medication Adherence for diabetes medications
Note: There are no changes for the pediatric program for MY 2025. Here is a high-level summary of the QPM measure changes compared to MY 2024.
1
| Breast Cancer Screening
| Aggregate
| Aggregate
| 2
| Colorectal Cancer Screening
| Aggregate
| Aggregate
| 3
| Cervical Cancer Screening
| Aggregate
| Aggregate
| 4
| Controlling High Blood Pressure
| Aggregate
| Aggregate
| 5
| Diabetes Care - Eye Exam
|
Combination measure; Aggregate population
| Aggregate
| 6
| Diabetes Care - HbA1c Good Control (<8%)
| Commercial only
| 7
| Diabetes Care - Kidney Health Evaluation
| Aggregate
| 8
| Diabetes Care - HbA1c Control (<=9%) - add to QIPS for Medicare Advantage only - NEW
| Medicare Advantage only
| 9
| Osteoporosis Management
| See Index 16
| Retire
| 10
| Statin Therapy for Patients with Diabetes - Dispensed (SPD)
|
Combination measure; Aggregate population
| Commercial only
| 11
| Statin Therapy for Patients with Cardiovascular Disease - Dispensed (SPC)
| Aggregate
| 12
| Medication Adherence for Cholesterol
| Aggregate
| 13
| Medication Adherence for Hypertension
| Aggregate
| 14
| Medication Adherence for Diabetes Medications
| Aggregate
| 15
| Statin Use in Patients with Diabetes (SUPD) – Adherence - NEW
| Medicare Advantage only
| 16
| Other clinical quality measures composite (AAB, WCV, OMW, PBH)*
| Aggregate
| Retire
| 17
| Primary Care Visit
| Medicare Advantage
| Medicare Advantage
| 18
| Well Visit Composite (WV30, Childhood and Adolescence)
| Commercial
| Commercial
| 19
| Vaccination Composite (CIS, Adol)
| Commercial
| Commercial
|
Aggregate = Medicare Advantage and Commercial member population is combined; Combination = Multiple measures are combined into one.
*AAB =
Avoidance of antibiotic treatment for adults with acute bronchitis/bronchiolitis; WCV = Well-care visits;
OMW = Osteoporosis management in women who had a fracture; PBH =
Persistence of beta blocker treatment after a heart attack
How to opt in
Use the Analytics & Reporting (AR) application on the
PEAR portal to complete the opt-in process. Practices must complete the opt-in process annually to participate. Failure to opt-in will exclude your office from the program in MY 2025. Please review and affirm or correct pre-populated information as you complete the opt-in process. Note: We have extended the opt-in period to the end of January. Going forward, opt in will occur from October 1 to January 31 of the following year. Note, completion of the annual Satisfaction Survey is required prior to opting in. We encourage all personnel (clinical and administrative staff) to complete the survey so we can capture well-rounded feedback.
Review these resources to help you during the opt-in process: -
QIPS Program Guide. The guide for MY 2025 will soon be available on the
PEAR Help Center under Analytics & Reporting – Value-Based Programs. We will post an update once it is available for your review.
-
QIPS Opt-in User Guide. A step-by-step guide to the PEAR AR opt-in process.
If you did not opt in to the QIPS program for MY 2024, you will be asked to identify an Office Champion and a Clinical Champion for 2025.
TIP: Identify the Office and Clinical Champions
before you begin for a smoother process.
For more information regarding the QIPS opt-in process, please email
Jennifer Kennedy. If your question is of a clinical nature, please contact
Ellen Riccobene, M.D. or
Luz Ramos, M.D.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.
| 10/7/2024 | | Updates |
QIPS program updates The following resources are now available in the
PEAR Help Center under Analytics & Reporting – Value-Based Programs for your review. Sign-in is required. -
QIPS Program Guide for MY 2024. Please note the highlighted changes below for MY 2024 and review the guide for more detail.
-
Quality targets. Based on updated CMS and NCQA national standards, the quality targets were updated in the Quality Performance Measure (QPM) score program for MY 2024.
-
QPM quality measures. The below highlights some important changes to the QPM quality measures for MY 2024. Please refer to the updated
Gap Closures Guides and the
Advanced Illness and Frailty Exclusion Guide in the
Help Center for more information about each measure.
- The former Hemoglobin A1c (HbA1c) Control for Patients with Diabetes measure was revised to Glycemic Status Assessment for Patients with Diabetes.
- Gender-inclusive language was added to Breast Cancer Screening and Cervical Cancer Screening.
- For QPM measures that pertain to diabetes (i.e., statin dispensed based on disease prevalence, eye exam), the denominator has been revised to include a diagnosis of diabetes when evaluating pharmacy claims and ≥2 encounters from any setting with a diabetes diagnosis.
-
QIPS opportunity chart. In Section 4 of the guide (page 11), an incentive opportunity chart has been added to provide the total earning opportunity available in the program.
-
QIPS Program Guide for MY 2023. The MY 2023 guide was revised to include the updated targets for Colorectal Cancer Screening. Earlier this year, a notification was sent to QIPS providers informing of the age change to 45 for colorectal cancer screening for MY 2023. National ratings were recently released to incorporate the adjusted age change. Therefore, the targets for MY 2023 were adjusted to reflect the new information.
Updated report For MY 2023, we introduced a new incentive for Medicare Advantage members: Transitions of Care: Follow-up after ED (emergency department) visit for members with multiple high-risk chronic conditions. A new field has been added to the
ED and UC Visit Analytics report to help you identify those patients with multiple chronic conditions who require a follow up. Please refer to the video available in the
Help Center for a refresher of this report.
Important reminder The opt-in window for MY 2024 is open. If you have not opted in and would like to be eligible and measured in QIPS 2024, please complete the opt-in process
by January 5, 2024. For more information regarding the QIPS program, please email
Jennifer Kennedy. If your question is of a clinical nature, please contact
Ellen Riccobene, M.D. or
Luz Ramos, M.D.
| 12/13/2023 |
|