• Quality Incentive Program 2018

  • Affinity Health Plan’s 2018 Provider Quality Incentive Program (2018 QIP) includes key indicators of focus for our primary care providers (PCPs). Affinity is offering the incentive program for all our lines of business – Medicaid, CHP, HARP, Essential Plan and Medicare.

    The 2018 QIP addresses the following Quality Incentive Program goals:

    1. To ensure the QIP is aligned with the Plans’ HEDIS/QARR goals;
    2. To maximize the Plan’s potential to improve year-over-year performance in a cost effective manner, and;
    3. To ensure that the right measures and stakeholders are appropriately and effectively rewarded for meeting and exceeding the Plan-defined benchmarks.

    Medicaid QIP

    Eligibility Requirements

    • Provider must have a minimum of 150 Medicaid/CHP members in their panel and at least 10 members within a given measure’s eligible population.
    • Provider must have an active Provider Portal account.
    • Provider must be enrolled in EFT/ERA.
    • Provider must have electronic medical records.
    • Provider must have capability of exchanging data electronically with the Plan (e.g., supplemental data submissions, HL7 data exchange, etc.)

    QIP Measures

    • For pediatric practices, the pediatric measures are used to determine bonuses. Click here to view pediatric measures.
    • For adult practices, the adult measures  are used to determine bonuses. Click here to view adult measures
    • Practices that treat pediatric and adult members are eligible for both pediatric and adult measures for bonuses.
    • The target for payment is the 90th HEDIS level for all measures.

    Medicare QIP

    Eligibility Requirements

    • Provider must have a minimum of 50 Medicare members and 10 members/measures in their panel.
    • Provider must have an active Provider Portal account.
    • Provider must be enrolled in EFT/ERA.
    • Provider must have electronic medical records.
    • Provider must have capability of exchanging data electronically with the Plan (e.g., supplemental data submissions, HL7 data exchange, etc.)
    • The target for payment is the Medicare 4-STAR level for all measures.

    Bonus Payout Structure

    For the Medicaid QIP measures the potential bonus amount is $100 per compliant member for target HEDIS rate obtained.

    The sample below illustrates how that would be calculated:

    Practice A has 1,200 Medicaid members, all adults. Of that number, 200 were eligible for the colorectal cancer screening measure. A total of 130 members met the measurement.

    • Denominator: 200
    • Numerator: 130
    • Percentage: 65
    • Threshold: 64.23% (met)

    Payout is earned and calculated as 130 compliant members X $100 per member = $13,000 for that measure.

    For the Medicare QIP measures the potential bonus amount is $100 per compliant member for the target STARS score achieved. The calculation of the bonus is the same methodology as outlined above for Medicaid.