We’ve made updates to our 2022 PIP manual

An updated 2022 PCP Incentive Program (PIP) manual is now available on our website.

PIP manual updates include

Clinical+

We’ve cancelled the launch of Clinical+ based on pilot feedback. All references to Clinical+ are removed from the manual.

2022 Program measure grid (pg. 5)

Removed the payout for the Medication Therapy Management (MTM) measure for the Medicaid. This measure is only applicable to commercial and Medicare members.

Attribution model (pgs. 6-8)

  • Changed title of step 2 to “Assignment/Member Declared”
  • Documented when members are, and are not, attributed in step 3 of the model
  • Added Place of Service (POS) 10 to the codes set

PCP to ACN relationship (pg. 12)

Changed the schedule for Provider Roster Application (PRA) snapshots to quarterly for the 2022 program year

Target rationale (pg. 14)

Added this section to provide transparency on how targets were set for the program year

Care for Older Adults (pgs. 26-27)

  • Clarified ”at least one medication review and the presence of a medication list in the medical record” is one of the requirements for evidence of a medication review
  • Added “Use the appropriate CPT, CPT II, and/or HCSPCS codes to report compliance for each component” to the method of measurement section
  • Added notes section including codes applicable to each component of the measure as well as the link to the QRS technical guide

Kidney Health Evaluation for Patients with Diabetes (pg. 45)

Removed “report only” from measure heading

Statin Use Therapy for Patients with Diabetes (pg. 47)

Added exclusionary codes to the code set at the end of the manual

Statin Use Therapy for Patients with Cardiovascular Disease (pg. 48)

Added exclusionary codes to the code set at the end of the manual

Medication Adherence for Diabetes Medications (pg. 50)

  • Removed “members enrolled in inpatient or skilled nursing facilities within the measurement year” from exclusionary criteria
  • Corrected language in denominator and notes section to indicate “members must have one prescription fill no later than Oct. 1, 2022”

Medication Adherence for Hypertension (RAS antagonists) (pg. 52)

  • Removed “members enrolled in inpatient or skilled nursing facilities within the measurement year” from exclusionary criteria
  • Corrected language in denominator and notes section to indicate “members must have one prescription fill no later than Oct. 1, 2022”

Medication Adherence for Cholesterol (Statins) (pg. 54)

Corrected language in denominator and notes section to indicate “members must have one prescription fill no later than Oct. 1, 2022”

Social Determinants of Health (pg. 68)

Corrected the report name to, “PIP_014 – PIP SDoH (TAB)”

Health information exchange participation with MiHIN (pg. 70)

Corrected the method of measurement language to state, “ACN must have active participation in at least 5 out of 7 of the above MiHIN use cases by Dec. 1 of the current program year”

Behavioral Health Collaborative Care (pgs. 73)

Added licensed professional counselor (LPC) as an acceptable behavioral health care manager

Code sets (pgs. 126, 129)

Added POS 10 to the codes sets for the Social Determinants of Health (SDoH) measure and the attribution model