2021 CPC+ and PCP Incentive Program manual available

The 2021 PCP Incentive Program (PIP) manual has been updated and is available on priorityhealth.com. Access the new 2021 PCP Incentive Program manual (login required).

Overview of 2021 program changes

2021 new measures

  • Childhood immunizations: Combo 10 (report only) – New as of December 23 for the finalized manual
  • 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

Updated target sources to each measure for clarification

Medicare targets are based on CMS Medicare 5 Star cut points plus a predictive factor. See individual measure specifications for details.

Added clarification to measures and administrative details based on feedback from the network

Refer to the notes section for the following measures:

  • Care management incentive
  • Social determinants of health (SDoH)
  • Medication therapy management (MTM)
  • Behavioral health collaborative care (BHCC)

Additional details on the final 2021 PIP manual

  • Program measure grid (pg.5)
    The grid provides an overview of the incentive program. It includes the measure, product payout, and product target. Medicare and Medicaid payouts are now available in the grid. Medication Therapy Management incentive has been revised based on network feedback. Please refer to the MTM technical specification for additional details.
  • Administrative details (pg. 10)
    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. 12)
    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
  • Childhood immunizations: Combo 10 (report only) (p. 18)
    HEDIS will retire Childhood Immunizations Combo 3. Childhood Immunizations: Combo 10 will be the replacement measure in 2022.
  • Well-child visits 15-30 months (report only) (pg. 24)
    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. 25)
    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. 42)
    This is a new HEDIS measure in 2021. Performance will be monitored in 2021 making this a report only measure.
  • Optimal diabetes care (pg. 44)
    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. 61-71)
    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 SDoH (pg. 72)
    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. 75)
    Based on provider network feedback this measure has been changed from our preliminary manual release. Practices earn a total payment of $171 per completed CMR:
    • $96 dollars paid per completed CMR monthly via the Outcomes MTM enhanced fee schedule rate
    • $75 dollars paid per completed CMR award at year-end settlement

    Product lines: HMO/POS, ASO/PPO, Medicare

    Due Mar. 12, 2021: MTM point of care attestation survey AND signed practice collaborative agreement between physician and pharmacist(s).

    Outcomes MTM platform provides reliable, real time accurate identification of eligible targeted members. Priority Health will no longer generate reporting for this measure (11J & 11K).

  • Health Information Exchange participation with MiHIN (pg. 78)
    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. 79)
    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. 81)
    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. 84)
    This measure will be report only in 2021.
  • Emergency department utilization (report only) (pg. 86)
    This measure will be report only in 2021.
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