2023 PIP manual is now available

Our final 2023 PCP Incentive Program (PIP) manual is now available online. You can find the manual on the PCP Incentive Program webpage. (login required)

Continuing the 2022 PIP model

The model used for the 2022 performance year will continue into 2023 for HEDIS®, Medicare 5-Star and Care Management, with a few adjustments previously announced:

  • ACN-level reporting and settlement
  • ACN eligibility
  • Chronic Disease Management Focus Measures pre-payment
  • Monthly attestation in our Provider Roster Application (PRA) tool
  • Filemart reporting

You can find details about these updates in the 2023 PIP Manual.

HEDIS Provider Guide

You’ll notice the updated PIP manual doesn’t include specifications for each measure. This is by design.

Providers will use our HEDIS Provider Reference Guide, which includes for each measure:

  • Billing codes
  • Optional exclusions
  • Services to close the care opportunity
  • Medical record documentation
  • Tips & best practices

Introducing chronic disease management focus measures

To get you funding earlier in the year, each quarter your ACN will receive estimated pre-payments for two chronic disease measures:

  • Hypertension: Controlled Blood Pressure
  • Diabetes Care: HbA1c ≤ 9.0%

We’re calling these “chronic disease management focus measures,” pre-paying you for the work using a 75th percentile reward rate. At year-end settlement in June 2024, we’ll review performance in these measures and adjust your settlement reward based on actual performance and membership. We won’t recover pre-payments below the 75th percentile performance.

Collaborating with ACNs for 2024+

We’ll meet with ACN leadership throughout 2023 to plan for 2024 focus measures and get their recommendations for further closing the gap between care delivery and reward.