2021 PCP Incentive Program (PIP) preliminary manual available

Our CPC+ and PCP Incentive Programs have been updated for the 2021 program year. To make things easier for you, we’ve combined the two programs into one manual.

Review our 2021 preliminary manual

Overview of 2021 program changes

2021 New Measures

  • Well Child Visits 15 – 30 Months (Report only)
  • Kidney Health Evaluation for Patients with Diabetes (Report only)
  • Social Determinates of Health (SDoH)
  • Health Information Exchange Participation with MiHIN
  • Behavioral Health Collaborative Care

2021 Revised Measures

  • Well Child Visits 3 – 11 Years
  • Optimal Diabetes Care
  • Care Management
  • Medication Therapy Management (MTM)
  • Healthy Michigan Plan (HRA)
  • Acute Hospital Utilization (AHU) (Report only)
  • Emergency Department Utilization (EDU) (Report only)

Retired Measures

  • Depression Screening and Follow up
  • Medicaid Patient-Centered Medical Home (PCMH)
  • Risk Adjustment
  • CG CAHPS

Detailed measure changes included:

Program measure grid (pg.6)

The grid provides an overview of the incentive program that includes the measure, product payout, and product target. Please note that we are still waiting for final targets from CMS for Medicare and Medicaid. We will update the manual once those targets are received. We anticipate these targets to be released in November.

Administrative details (pg. 11)

We combined the PCP IP and CPC+ manuals for ease of use in 2021. Please note that the care management measure now has two separate technical specifications; one for standard PIP practices providing care management services and the other for CPC+ track 1 and 2 practices providing care management services.

Program deadlines (pg. 13)

Program deadlines changed for the following measures:

  • 2021 settlement date will be on or around Jun. 1, 2022
  • Medication therapy management attestation and signed collaborative practice agreement due on same date; March 12, 2020
  • Transformation of Care measures (SDoH and BHCC) will require the completion of an attestation survey

Well Child Visits 15 – 30 Months (Report only) (pg. 21)

This is a new HEDIS measure in 2021. Performance will be monitored in 2021 making this a report only measure.

Well Child Visits 3 – 11 Years (pg. 22)

HEDIS revised this measure to include children between the ages of 3-11 years old instead of 3-6 years old. Priority Health will use 2020 health plan 75th percentile performance as the 2021 target. This target will be available prior to 2nd quarter of 2021.

Kidney Health Evaluation for Patients with Diabetes (Report only) (pg. 39)

This is a new HEDIS measure in 2021. Performance will be monitored in 2021 making this a report only measure.

Optimal Diabetes Care (pg. 41)

Now includes the following diabetes measures:

  • Diabetes care: Controlled HbA1c less than 8%
  • Diabetes care: Annual retinal eye exam
  • Diabetes care: Controlled blood pressure (if applicable)

Diabetes Care: Monitoring for nephropathy now applies only to Medicare and therefore was removed from the optimal care measure.

Care Management – Standard PIP practices and Care management – CPC+ practices (pg. 58-68)

Removed the attestation requirement. These measures new require the following components:

  • Component 1: Active PCMH recognition
  • Component 2: QHP licensure
  • Component 3: QHP training
  • Component 4: QHP continuing education
  • Component 5: Claims submission

Social Determinates of Health (pg. 69)

The measure requires four components:

  • Component 1: Active PCMH recognition
  • Component 2: Screening for SDoH
  • Component 3: Survey attestation
  • Component 4: Billing z-codes

Medication Therapy Management (MTM) (pg. 72)

The eligibility criteria for targeting Medicare members and Medicare targets have changed. This change is a result of OutcomesMTM eligibility criteria that impact the denominator in this population. This narrowed targeting criteria targets those populations that, based on evidence, realize the greatest benefit to receiving a CMR.

2021 CMR Targeting Criteria

 Drug spend threshold AND

≥ 8 chronic medications AND

≥ 3 of the following disease states: 

 Asthma
 CHF
 COPD
 Diabetes
 Dyslipidemia
 Hypertension

 

Health Information Exchange Participation with MiHIN (pg. 75)

ACNs contracted with MiHIN and participating in at least 4 out of 6 identified use cases are eligible for a pmpm incentive across all products. Attestation is not required. Participation status will be provided by MiHIN.

Healthy Michigan Plan (HRA) (pg. 76)

The incentive payout for CHAMPS submission of a completed HRA has been increased while the incentive payout for fax submission of completed HRA has decreased.

  • CHAMPs - $70
  • Fax - $15

Behavioral Health Collaborative Care (pg. 78)

The measure requires three components:

  • Component 1: Active PCMH recognition
  • Component 2: Education and attestation
  • Component 3: Priority Health meeting attendance/collaboration

Acute Hospital Utilization (Report only) (pg. 81)

This measure will be report only in 2021.

Emergency Department Utilization (Report only) (pg. 83)

This measure will be report only in 2021.