Preliminary 2024 PCP Incentive Program (PIP) manual is now available

The preliminary 2024 PIP manual is now available for download (login required). The final manual including targets and payouts will be released to the network on or around Dec. 1, 2023.

Overview of program changes

Focus measure pre-payments

We’ve updated the focus measure pre-payment calculation for 2024, from 100% of the denominator to 75% of the denominator.

We’ll take a snapshot of each ACN's population in each focus measure in early 2024 to determine the denominator. We’ll then pre-pay ACNs at the 75th percentile reward amount for 75% of the denominator (excluding all ASO/PPO members).

At settlement, we’ll review each ACN’s actual population and performance for these measures and pay any additional dollars earned. Regardless of performance, we won’t take back pre-paid dollars from your ACN.

Administrative changes

  • Digital First data strategy, including the retirement of the PIP_70 report and Patient Profile

Revised measures

  • Added two pediatric focus measures
  • Simplified the payout methodology for the focus measure to prevent recovery of any prepaid payments
  • Care management measure
    - Add CPT codes for touchpoint credit
    - Simplify the link to quality
    - Added a second Social Determinants of Health (SDoH) measure

Detailed measure changes

Program measure grid (pg. 6)
The product payout and product targets will be provided in the final manual. The grid provides an overview of the incentive program, including the measure, product payout and product target.

Administrative details (pg. 7-11)
We’ve updated components of our administrative details to better communicate the program.

Focus measure pre-payments (pg. 13)
Added two focus measures for pre-payment:

  • Well Child Visits 3-11 years (WCV)
  • Well Child Visits 0-15 months (W30)

Updated the pre-payment calculation to pay ACNs at 75% (rather than 100%) of the measure denominator, guaranteeing ACNs will keep the entire pre-payment.

Care Management (pg. 14-17)

  • Updated Component 4 to require ACNs to meet or exceed the 90th percentile in any three preventive and/or chronic disease measures by product.
  • Added five CPT codes for touchpoint credit.

Social Determinants of Health (SDoH) (pg. 18-20)
Added an SDoH screening measure with two G codes for positive and negative screenings. The screening target is 70% of the eligible population.

Appendix 2: Guidelines for reporting care gap closure (pg. 32-33)
Added this appendix to support ACNs in our Digital First data strategy.

Appendix 4: CPT® II Codes (pg. 36-39)
Added this appendix to support ACNs in our Digital First data strategy, calling out which CPT II codes will close PIP care gaps.

Appendix 5: Report inventory (pg. 40-41)
Updated to include MiHIN / HL7 confirmation reports that can be made available to ACNs upon request.