Priority Health - Updates to 2020 Incentive Programs

August 18, 2020

We’ve revised our PCP Incentive Program (PIP) and Comprehensive Primary Care (CPC+) Program to reflect updated HEDIS information. Several measures have added additional opportunities for gap closure and/or exclusion criteria. In addition, we’ve made changes to the Healthy Michigan Plan: HRA measure which will be effective with the next Filemart report release. HEDIS measure changes are effective July 1, 2020.

 

In alignment with NCQA and CMS, there will be no changes to measurement targets for 2020. We recognize this year has been challenging, and we’ve worked to give you opportunities to provide needed care to your patients. These changes include more options for telehealth along with eliminating, or reducing, member cost share to encourage patients to get care.

 

We will be announcing a bonus program where you can earn incentives for meeting targets with our most vulnerable populations. Learn more at our September 9 Provider Network Leadership Forum. If you cannot attend look for an email that day.

 

Technical manual measure changes

Hypertension: Controlled blood pressure

Changes were made to the language used in the Identified measure section:

  • Added any digital device is acceptable.
  • Added digital BP results can be reported and/or taken by the member.
  • Added all blood pressure readings must be documented in the medical record.
  • Added BP readings taken by the member using a non-digital device (ex. manual BP cuff) aren’t acceptable.

Changes made to the language used in the Case definition section:

  • Revised the timeframe to look for two outpatient visits with a diagnosis of hypertension in the first six months of the measurement year and the year prior to the measurement year.
  • Removed the restriction that only one of the two visits with a hypertension diagnosis be an e-visit or virtual check-in.

Changes made to the language used in the Exclusion criteria section:

  • Added telephone visits, e-visits and virtual check-ins to the advanced illness exclusion.
  • Added palliative care as a required exclusion.

Well-child visits in the first 15 months of life and well-child visits 3-6 years

  • Removed the telehealth exclusion.

Diabetes care: Annual retinal eye exam

  • Added eye exam results read by a system that provides an artificial intelligence (AI) interpretation meets criteria.
  • Added palliative care and polycystic ovarian syndrome exclusion.
  • Added telephone visits, e-visits and virtual check-ins to the advanced illness exclusion.

All diabetes measures

  • Removed the identifying event/diagnosis restriction that states only one of the two visits with a diagnosis can be an outpatient telehealth, telephone visit, e-visit or virtual check-in.
  • Added telephone visits, e-visits and virtual check-ins to the advanced illness exclusion.
  • Added the exclusion of members with the diagnosis of polycystic ovarian syndrome, gestational diabetes and steroid-induced diabetes who don’t also have the diagnosis of diabetes within the measurement year or the year prior to the measurement year.
  • Added the exclusion of members in hospice, using hospice services or receiving palliative care at any time during the measurement year.

 

Breast cancer screening / colorectal cancer screening

  • Added telephone visits, e-visits and virtual check-ins to the advanced illness exclusion.

Palliative care exclusionary criteria added to the following measures

  • Breast cancer screening
  • All diabetes measures
  • Colorectal cancer screening
  • Cervical cancer screening
  • Opioid utilization - reporting only 

Healthy Michigan Plan:  HRA completion

  • Added completed HRA form submitted by a mid-level provider (billing under the credentialed participating Primary Care Physician) as eligible for a tiered incentive for proper completion and submission. The mid-level provider completing the HRA doesn’t need to be credentialed. Credit for the completed HRA will be applied to member’s assigned PCP on the date of service. 

 

The next Filemart report release will reflect the Healthy Michigan Plan: HRA change.

 

You can access updated manuals at priorityhealth.com.

  • 2020 PCP Incentive Program manual (login required)
  • 2020 CPC+ Incentive Program manual (login required)

Thank you for your continued partnership.