Preliminary 2025 PIP Manual now available

After months of planning, in collaboration with ACN leaders and network physicians, the Preliminary 2025 PCP Incentive Program Manual (login required) is now available. The final manual, including targets and payouts, will be released on or around Dec. 1, 2024.

Below is a high-level overview of the 2025 PIP program and updates made in the preliminary manual. Please take time to review the full manual for more detail.

Program overview

The 2025 PIP program includes the following components:

  • HEDIS preventive health, chronic disease management and Medicare 5-Star measures – including a new measure, Social Needs Screening & Intervention (SNS-E)
  • Access to Care measure (new) –rewarding PCP offices for innovation beyond “business as usual” in engaging our hardest-to-reach members
  • Disparity of Care measure (new) – addressing differences and/or gaps in the quality of health care access across racial, ethnic and socio-economic groups, based on MDHHS guidelines
  • Transformation of Care measures – including a monthly prepaid Care Management PMPM; continued Behavioral Health Collaborative Care (BHCC) reward; and Health Information Exchange with MiHIN in support of our digital first strategy

Overview of program changes

Administrative changes

  • Settlement level: HEDIS preventive health, chronic disease and Medicare 5 Star measures will be settled at the practice group level. Access to Care, Disparity of Care and Transformation of Care measures will be settled at the ACN level.
  • Membership lock date: A PCP’s membership for settlement will be locked on October 31. Measure settlement will be based on the PCP’s assigned / attributed membership as of October 31.
  • Focus measure pre-payments: Quarterly focus measure pre-payments were retired.
  • Plan exclusions: ASO / PPO plans are excluded from the Transformation of Care measures.

Revised measures / elements

  • Program measure grid (pg. 6): 75th percentile targets were removed for all measures except for Disparity of Care. The product payout and product targets will be provided in the final manual.
  • Well Child Visits: 3-21 years (WCV) (pg. 6): Expanded pediatric wellness measures to cover members up to 21 years of age
  • Administrative details (pg. 7-13): Updated components of our administrative details to better communicate the program
  • Care Management (pg. 20-23): Monthly prepayment; only 1 of 2 touchpoints can be met with a telephone management code; removed quality measure component
  • Behavioral Health Collaborative Care (BHCC) (pg. 24-25): Removed add-on code (99494)

Retired measures

  • Social Determinants of Health (SDoH) screening
  • SDoH z-code reporting

Access the manual

To access the Preliminary 2025 PIP Manual online:

  1. Log into your prism account.
  2. Scroll down to the bottom of the homepage and click Provider Incentives Program.
  3. Click PCP Incentive Program then the Preliminary 2025 PIP Manual button.