2016 Provider Quality Incentive Program

Like you, quality performance is important to California Health & Wellness. Every day we strive to ensure our members are receiving high quality care, when they need it and where they need it. Your partnership helps us achieve our goal, which is why we are launching our new Quality Incentive Program. The focus of this program is to provide our provider partners three potential incentive bonus opportunities based on HEDIS performance improvement starting in July 2016.

  1. Patient Level Compliance Bonus: All California Health & Wellness primary care providers (PCP) are eligible to earn an incentive for converting their noncompliant HEDIS patient listings to compliant.

    • Bonus Payout: By October 31, 2016 for services in July through September
    • Bonus Payout: By March 31, 2017 for services in July through December (If the encounter was not captured previously)

      It’s important to keep in mind that compliance is based on NCQA HEDIS measure specifications and must be received as a medical claim with the correct coding or by submission of the medical record with the correct documentation that meets measure compliance guidelines 
  2. Provider Quality Performance Ratings: For those high volume providers who serve as a PCP (based on Tax Identification Number) for more than 1,000 members as of December 31, 2016, they will also be eligible for additional payments based on their cumulative HEDIS performance at the end of the year. This will be based on a 4 Star Rating Scale. This star rating will become part of our ongoing quality improvement program. Please consider accepting more CH&W members so you too can participate in this additional incentive bonus opportunity.

    • Bonus Payout: By March 31, 2017
  3. Notice of Pregnancy (NOP) Bonus: Improving Prenatal Care is a critical goal for California Health & Wellness and early identification of patients increases the likelihood of a successful and healthy pregnancy. Providers are asked to complete a NOP form for every patient with a new diagnosis of pregnancy. For every new NOP submitted for patients in their first trimester, you will receive a bonus of $75 for each one if you are the first provider to submit it. This is an Ongoing Bonus Payout, which started in October 2015.

Our Quality Incentive Program is just the first step to building a high quality program. In addition, we have improved our HEDIS Status Report (HSR) to provide you a clear snap shot of your California Health & Wellness patients who meet the NCQA criteria which places them in the HEDIS denominator. You will receive this report monthly with a year-to-date status indicating which patients require services to meet the HEDIS measure criteria. It is a tool to support you in delivering the highest quality care and it provides details you need to reach your bonus payout potential.

In Addition

If you are interested in the 2017 Provider Incentive Program we will be releasing the new 2017 Provider Incentive Details and Training Webinar soon. Please check back in the coming weeks for details.