To maximize the quality of care for its health plan members, CenCal Health has launched an innovative program named Quality Care Incentive Program or QCIP. Effective March 1, the pay-for-performance program aligns financial incentives to healthcare providers with excellence in clinical care of health plan members.
CenCal Health is a Medi-Cal plan that partners with some 1,500 local physicians, hospitals and other providers in delivering patient care to 210,000 members in Santa Barbara and San Luis Obispo counties.
Replacing five different incentive programs previously utilized, the single integrated QCIP will more extensively support primary care providers (PCP) to achieve excellence in quality care. Medi-Cal is the name of California’s Medicaid benefits program; Medicaid is administered by the federal government.
In 2003, the Centers for Medicare & Medicaid Services established pay-for-performance initiatives to control healthcare costs and increase access to care by encouraging more physicians to participate in Medicaid health plans. More recently, incentive programs have evolved to place emphasis on quality of care, especially on prevention and management of chronic conditions.
QCIP emphasizes the clinical priorities of significance to CenCal Health members, such as diabetes and asthma care, breast cancer and cervical cancer screenings, and child and adolescent well-care visits. Performance is measured monthly and in accordance with pre-defined, industry-standard, measurement specifications maintained by the National Committee for Quality Assurance (NCQA).
“We designed this incentive program to encourage increased utilization of evidence-based treatment, screening, and preventive health services,” said Carlos Hernandez, CenCal health quality Officer. “Performance is based on how often the standard of care is met. And no measures used in CenCal Health’s payment calculations encourage withholding of services.”
QCIP includes five measure domains, encompassing 13 clinical measures, as follows:
• Behavioral Health Care
Antidepressant Medication Management ‐ Acute Treatment
Antidepressant Medication Management ‐ Continuing Treatment
• Diabetes Care
HbA1c Testing
Retinal Eye Exams
• Respiratory Care
Asthma Medication Ratio
• Women’s Health Care
Breast Cancer Screening
Cervical Cancer Screening
Chlamydia Screening
• Pediatric Care
Lead Screening in Children
Immunizations for Adolescents
Well Child Visits in the first 15 Months of Life
Well Child Visits in the first 30 Months of Life
Child & Adolescent Well‐Care visits
To develop and execute QCIP, CenCal Health’s quality management team, under the direction of Hernandez, collaborated with all internal departments at the local health plan, and external organizations such as the California Department of Health Care Services, as well as representative primary care providers.
“The new Quality Care Incentive Program is an innovative step forward in CenCal Health’s strategy to ensure equitable health care for all,” said CenCal Health CEO Marina Owen. “QCIP reinforces our enduring partnership with providers, and meaningfully recognizes them.”
For more on CenCal Health, visit cencalhealth.org.