Provider news

PCP Incentive Program and CPC+ Program targets, measures updated

The 2017 PCP Incentive Program and CPC+ Program support your efforts to provide the best clinical care while balancing cost and patient experience, a structure that directly reflects the Triple Aim.

Edits to the programs as of July, 2017

We want to make you aware of recent changes to measurements in both programs. Among the changes are:

  • Measure targets and payout are now available for MTM and all-cause readmissions
  • Payout methodology for care management was updated to reflect risk adjustment for CPC+ and the PCP Incentive program for Priority Health ACA individual members
  • Additional depression codes were added

New/revised pages for the manuals

Please print and update your binder with the following new or revised pages:

PCP IP Manual: Pages 23, 32, 40, 41, 42, 44, 47, 48, 49, 53, 57, 82, 83

CPC+ Manual: Pages 22, 31, 38, 39, 40, 41, 42, 43, 46, 47, 48, 52, 56, 81, 82

Measures impacted

Colorectal cancer screening (PIP pg. 23) (CPC+ pg. 22): Changed the numerator section. 

Hypertension: Controlled blood pressure (PIP pg. 32) (CPC+ pg. 31): Changed case definition section

MTM (PIP pg. 39) (CPC+ pg. 38): Added measure targets and payment for HMO/POS, ASO/PPO, Medicare and Medicaid 

Care management (PIP pg. 40-42) (CPC+ pg. 39-41):

  • Revised/added to the identified measure section 
  • Added risk adjustment and payout for patients/members covered by Priority Health Affordable Care Act (ACA) individual products (“Payout” section) 
  • For CPC+ only - Added payout and risk adjustment information ("Payout" section) 
  • Added to the Notes section 

PCMH (PIP pg. 43) (CPC+ pg. 42): Added to the Notes section 

CG CAHPS® (PIP pg. 44) (CPC+ pg. 43): Added to the Notes section

All-cause readmissions (PIP pg. 47-48) (CPC+ pg. 46 -47): Added target, improvement and shared savings information 

ED PCP treatable care (PIP pg. 49) (CPC+ pg. 48): Added HMO/POS and Medicaid, target, improvement and shared savings information 

Codes set:

Well-child visits (PIP pg. 53) (CPC+ pg. 52): Removed the statement "3-6 years" 

Pediatric and adult BMI (PIP pg. 57 ) (CPC+ pg. 56): Added additional adult BMI codes

Depression code set (PIP pg. 82-83) (CPC+ pg. 81–82): Added additional depression screening codes

Log in and go to the PCP Incentives Program (PCP IP) page in the Provider Manual to see the 2017 plan changes and download the new 2017 Manual and measures chart.

Questions?

Contact your provider performance specialist. They can help you meet your program objectives.