2022 PCP Incentive Program (PIP) preliminary manual is now available

The preliminary 2022 PCP Incentive Program (PIP) manual is now available for download. (login required)The final manual including targets and payouts will be released to the network on or around January 2, 2022. 

Overview of 2022 program changes

New 2022 measures:

  • Care for Older Adults
  • Osteoporosis Management in Women who Had a Fracture

Revised 2022 measures:

  • Care Management
  • Social Determinants of Health (SDoH)
  • Health Information Exchange Participation with MiHIN
  • Behavioral Health Collaborative Care

Retired measures:

  • Optimal Diabetes Care
  • Medication Therapy Management
  • ED Visits: PCP Treatable
  • Acute Hospital Utilization (AHU)
  • Emergency Department Utilization (EDU)

Detailed measures changes include:


Program measure grid (pg.5)

The product payout and product targets will be provided in the final manual. The grid provides an overview of the incentive program. It includes the measure, product payout, and product target.

Attribution model (pg. 6)

We will be changing our attribution model beginning with the 2022 program year. An algorithm of the new attribution model that aligns with the industry standard definition of member attribution will be available with the final draft of this manual.

Glossary and administrative details (pg. 7-13)

We’ve updated many components of our glossary and administrative details to better communicate the program. Please take time to review these updates and familiarize yourself with the details of the program.

Care for Older Adult (pg. 26)

This is a new measure for our PCP Incentive Program in 2022. Care for Older Adults is a Medicare 5 Star quality rating measure for DSNP members 66 years and older who had each of the following during the measurement year:

  • Medication review
  • Functional status assessment
  • Pain assessment

Osteoporosis Management in Women who had a fracture (pg. 33)

This measures female Medicare members 67–85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the six months after the fracture.

Care Management (pg. 61)

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

  • Component 1: Active PCMH recognition
  • Component 2: QHP licensure, training, and continuing education
  • Component 3: Claims submission
  • Component 4: Meet or exceed three quality measures by product/population

Social Determinates of Health (SDoH) (pg. 67)

The attestation component of this measure has been removed. The measure requires two components:

  • Component 1: Active PCMH recognition
  • Component 2: Billing z-codes

Health Information Exchange Participation with MiHIN (pg. 68)

  • Added SDoH as an optional use case
  • ACNs contracted with MiHIN and participating in at least 5 out of 7 identified use cases are eligible for a pmpm incentive across all products
  • Attestation is not required
  • Participation status will be provided by MiHIN

Behavioral Health Collaborative Care (BHCC) (pg. 72)

The measure requires five components:

  • Component 1: Active PCMH recognition
  • Component 2: Implement a systematic case review (SCR) tool
  • Component 3: Implement collaboration with a psychiatric consultant
  • Component 4: Submit an attestation of compliance
  • Component 5: Attend quarterly Priority Health sponsored meetings to discuss BHCC