Quality Care Incentive Program
CenCal Health’s Quality Care Incentive Program (QCIP) identifies members who are due for clinically recommended services to help Primary Care Providers continue providing high quality health care for members. Providers can contact CenCal Heath’s Population Health
Department for more information at: email@example.com
The Quality Care Incentive Program Protocols are available to providers here.
The Quality Care Incentive Program Dashboard
A snapshot trended view of both a PCP’s overall program performance and their overall financial performance.
The Quality Care Incentive Program Performance Overview
A display of quality scoring for each PCP’s membership including:
- A PCP’s trended overall quality performance
- A PCP’s quality performance score by month
- A PCP’s quality performance score by measure and measure categories
- A PCP’s combined quality score for all measures
- Member’s due for various aspects of care
The Quality Care Incentive Program Financial Overview
A display of each PCP’s trended incentive payments as well as the trended incentive funding available to them including:
- A PCP’s financial payment performance by quarter
- A PCP’s financial quintile performance
- A PCP’s quarterly Payment Scoring Detail
For more information on navigating these portal sections, you can go to: CenCal Health’s Provider Training & Resources Page
Quality of care categories are identified for inclusion in the Quality Care Incentive Program based on various criteria such as areas of quality improvement for CenCal Health, the ability to accurately measure quality of care using available data, and alignment with state recommended quality focus areas.
Quality of care measures fall into six clinical categories of care:
- Behavioral Health
- Women’s Health
- Pediatric Care
- Diabetes Care
- Respiratory Care
- Cardiac Care
CenCal Health’s Quality Care Incentive Program quality measures encompass aspects of care that PCPs can influence either through direct care or through referral to specialists or other ancillary practitioners. Identified priority measures are consistent with accepted clinical guidelines and are clinically relevant to CenCal Health’s membership.
Measures are evaluated annually and as priorities regarding these criteria change, CenCal Health may update measures. Generally, measures remain in the program for at least 2 years and no less than 1 year.
Measures a separated into two categories:
- Priority Measures – Identified priority aspects of care included in incentive payment calculations
- Informational Measures – Identified aspects of care not included in incentive payment calculations
All measure requirements reflect the most recently available NCQA HEDIS® Volume 2 Technical Specifications and are updated as measure specifications change.
The Quality Care Incentive Program Measures can be found here.
Codes pertaining to the Quality Care Incentive Program can be found here.
® HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
CenCal Health strictly adheres to the HEDIS specifications and value sets in Quality Care Incentive Program reporting. To do so, CenCal Health licenses NCQA-certified software to perform measure calculations, all of which undergo an annual HEDIS Compliance Audit.
CenCal Health’s Population Health Department is available to:
- Provide PCPs with orientation regarding CenCal Health’s Quality Care Incentive Program
- Provide strategies to maximize PCP data reporting including electronic data sharing
- Share best practices to help PCPs maximize service utilization that is consistent with preventive health and clinical practice guidelines
- Provide quality improvement training (click here to view presentation slides)
- Provide PCPs with health education materials for their members
- Provide assess to the Provider Portal QCIP training video tutorials
How often does program reporting occur?
The Quality Care Incentive Program portal reporting module is updated monthly reflecting the previous 12 months of care rendered. Financial reporting will be updated quarterly as payments are calculated and generated.
How are Quality Care Incentive Program measures calculated?
Quality Care Incentive Program measures are calculated using current NCQA HEDIS® Volume 2 Technical Specifications which reflect the most recent clinical recommendations and preventive health guidelines that apply to the measurement periods.
How often are quality measures updated?
Generally, quality measures remain in place for at least 2 years to reinforce improvement priorities, support program stability for PCPs, and increase the ability to achieve clinical excellence.
Why aren’t some services or quality measures included in the Quality Care Incentive Program?
CenCal Health includes quality measures in the Quality Care Incentive Program that meet certain criteria such as needed clinical improvement, alignment with state-wide quality priorities, and the ability to measure quality of care accurately with available data. Quality of care measures that are not included in the Quality Care Incentive Program are measured through other processes. For example, annual MCAS auditing and Facility Site Reviews.
Which members are included in the Quality Care Incentive Program?
All CenCal Health Medi-Cal members are included in the Quality Care Incentive Program except those with Medicare as their primary insurance. Members also covered by Medicare are excluded because CenCal Health does not have access to complete claims data as evidence of their care.
How are quality of care scores calculated?
Quality scores are based on performance for all measures combined. These are calculated by dividing the total number of a PCP’s assigned members who received an aspect(s) of care, by the total number of assigned members who were due for an aspect(s) of care. Members are only included if they were covered by CenCal Health for sufficient time to receive recommended services.
What is the frequency of Quality Care Incentive Program payments?
The Quality Care Incentive Program (QCIP) payments are quarterly (March, June, September, December) and will reflect the most current performance achievements. Because four QCIP payments are made each 12 months, PCPs can earn the full annual withhold plus the CenCal Health contribution, within the rolling 12-month funding period.
What is my withhold percentage?
The Quality Care Incentive Program has two options for withhold amounts. FQHC typically have 40% and PCPs have a withhold amount of 20%.
- FQHC are encouraged to shift money outside of their capitation as this will guarantee a Fee for Service on top of the incentive amount. What CenCal pays is subtracted by the guaranteed amount while at the Federal and State level, they will pay the remaining.
- PCP have a less amount in their withhold as they only get their capitated amount
Does the Quality Care Incentive Program promote withholding of services for members?
The Quality Care Incentive Program only includes quality measures that promote increased utilization of medically needed services.
What are all the data sources used to calculate Quality Care Incentive Program scores?
CenCal Health uses all claims, lab, and registry data available at the time of reporting is to calculate Quality Care Incentive Program scores.
Who receives credit for referrals?
PCPs are only included in the Quality Care Incentive Program and their quality-of-care score includes referrals to specialized providers.
What information will be necessary to remove a patient who has moved out of the county, is out of the country, has deceased, has insurance, the phone number is out of service, or has chosen a different provider?
If the provider has a list of members that are deceased, who have moved out of the area or chose a different provider, the list can be emailed to Member Services call center manager: firstname.lastname@example.org with the corresponding details (for example the date of death, new out of county address, etc.).
This information is needed to report to the Department of Social Services, and they can confirm. CenCal Health cannot remove members from any provider list unless the member agrees to it.