2019-12: Revised PMPM Quality Incentive Program Launching on April 1, 2019
Date: 02/25/19
Beginning April 1, 2019, our Per Member Per Month (PMPM) quality incentive program for our in-network primary care providers will be updated to align with the Louisiana Department of Health (LDH) new quality measure priorities.
Please note: The PMPM incentive amount remains unchanged. As a valued primary care provider in our network, you will still be eligible for the same earnings amount based on the following performance criteria:
- Performance measure results will be determined using administrative claims data
- Data will be calculated after a 90-day claims lag (i.e., January data is evaluated in May)
- To be eligible for performance based PMPM, a practice must meet or exceed the established performance goal in the month being evaluated.
The updated program will be based on the following nine incentivized HEDIS performance measures:
| QUALITY PERFORMANCE INCENTIVE (HEDIS) MEASURES | NCQA QUALITY COMPASS BENCHMARKS FOR 2018* |
| Adult’s Access to Preventive/Ambulatory Care (AAP) | 50% Percentile of National NCQA Quality Compass |
| Adolescent Well Care Visits (AWC) | 50% Percentile of National NCQA Quality Compass |
| Comprehensive Diabetes Care-HbA1c (CDC) Comprehensive Diabetes Care-Retinopathy (CDC) Comprehensive Diabetes Care-Nephropathy (CDC) | 50% Percentile of National NCQA Quality Compass |
| Chlamydia Screening in Women (CHL) | 50% Percentile of National NCQA Quality Compass |
| Well-Child 3, 4, 5 & 6 (W34) | 50% Percentile of National NCQA Quality Compass |
| Well-Child (W15) | 50% Percentile of National NCQA Quality Compass |
| Ambulatory Care (AMB) | 50% Percentile of National NCQA Quality Compass |
Please note: Only measures for which you have at least 25 eligible patients will apply to your incentive. Calculations are based on specific thresholds of eligibility to ensure that our providers are not penalized for low performance on a measure that is not applicable to their practice. Providers who do not meet all the goals on all applicable measures will be eligible for a proportionate incentive amount based on the measures that are met.
Other preventive care incentives will not change. Providers can continue to earn incentives for submitting Notifications of Pregnancy, completing Postpartum Visits, performing Cervical/Breast Cancer Screenings, and administering 17P (or other Antenatal Progesterone).
In-network providers will soon begin receiving updated contract amendments with additional information about this updated incentive program as well as descriptions and coding information for each of the nine incentivized HEDIS measures. The contract amendment will automatically take effect on April 1, 2019. As a valued provider in our network, you do not need to do anything to participate in this incentive program.
For questions or additional support, please contact your dedicated Provider Consultant or call Provider Services at 1-866-595-8133.