Medi-Cal Provider Incentive Program
Blue Shield of California Promise Health Plan’s provider incentive programs are designed for our network primary care practices and Independent Practice Associations (IPAs) that provide high-quality healthcare services to our valued Medi-Cal plan members.
The goal of each program is to encourage providers to ensure that our members receive high-quality care that is sustainably affordable. We offer seven types of incentives to network participants, based on provider organization type and location.
We are here to assist you
To request more information about any of our Blue Shield Promise incentive programs, including an annual program description, please send an email to providerincentives@blueshieldca.com.
Incentive program for primary care practices
Patient-Centered Medical Home Certification
This program is available to primary care practices throughout California. Any primary care practice that is Patient-Centered Medical Home (PCMH) certified by the National Committee for Quality Assurance (NCQA) or The Joint Commission is eligible to participate in this incentive program. Only those locations which are PCMH-certified are eligible. The incentive is paid twice a year, in April and October.
Incentive programs for IPAs
Promise Quality Performance Incentive for Los Angeles County
Blue Shield Promise recognizes top-performing IPAs in Los Angeles County by providing an additional incentive on top of L.A Care's Value Initiative for IPA Performance (VIP) incentive.
The Promise Quality Performance Incentive for Los Angeles (PQPI LA) program focuses on three clinical quality measurement domains: Healthcare Effectiveness Data and Information Set (HEDIS®), Encounters and Member Experience.
The PQPI LA incentive will be paid in the December following the close of the measurement year. For example, the PQPI Program Measurement Year (MY) 2022 will be paid in December 2023.
Promise Quality Performance Incentive for San Diego County
Blue Shield Promise independently operates the Promise Quality Performance Incentive program in San Diego County (PQPI SD). The program is modeled after L.A. Care's VIIP program. By evaluating certain measures and sharing best practices with IPAs, Blue Shield Promise will reward top performing IPAs with the goal of encouraging higher quality in provided services.
PQPI SD focuses on two clinical quality measurement domains: Healthcare Effectiveness Data and Information Set (HEDIS) and Encounters.
The PQPI SD incentive will be paid in the December following the close of the measurement year. For example, the PQPI Program Measurement Year (MY) 2022 will be paid in December 2023.
Integrated Healthcare Association’s Align. Measure. Perform. for Medi-Cal Managed Care
The Integrated Healthcare Association’s (IHA's) Align. Measure. Perform. (AMP) Medi-Cal Managed Care Program is based on a common set of measures and benchmarks spanning clinical quality, patient experience, utilization, and cost-of-care measures. This program is available to all Blue Shield Promise network IPAs.
IPAs must confirm participation directly with IHA annually in order to be eligible for this program. Blue Shield Promise uses the AMP program scores to calculate an incentive payment, which is paid annually, approximately three months after IHA releases final measurement year results.
To learn more information about this program, visit the IHA website or send an email to Blue Shield Promise at providerincentives@blueshieldca.com.
Initial Health Appointment
At Blue Shield Promise, we are committed to providing access to high-quality care for our members and to providing supportive programs for the providers who deliver that care. That is why we are incentivizing our contracted provider network for performing Initial Health Appointments (IHAs) with new Blue Shield Promise Medi-Cal enrollees. Our IHA provider incentive program rewards our network providers for ensuring that each member who requires an IHA receives the care they need.
The Department of Health Care Services (DHCS) requires primary care providers to conduct an IHA for all new Medi-Cal members within 120 days of enrollment in a health plan. The IHA can be completed by a primary care physician, nurse practitioner, certified nurse midwife, or physician assistant. Incentive program payments are made to IPAs/medical groups quarterly.
Chronic Care Program for Medi-Cal Members
Blue Shield Promise supports the care of Medi-Cal members with chronic conditions through our Chronic Care Incentive Program. This program is available to Independent Practice Associations (IPAs) and medical groups to assist them in addressing the needs of members with chronic conditions through various assessments. Incentive payments for this program are made to IPAs/medical groups annually.
Complex Case Management
Our Complex Case Management program allows us to work directly with members and collaborate closely with their physicians to coordinate care and services to high-risk members.
Behavioral health services
Blue Shield Promise behavioral health services cover mental health, substance use disorder, and autism spectrum disorder behavioral health treatment.
Population health management
Our disease managment program provides education, care coordination, and support for members with certain chronic conditions.
Quality Improvement Program
Blue Shield Promise created a Quality Improvement Program (QIP) for all lines of business. This progrm allows us to identify opportunities for improvement of care and services to our members and providers.
Health education for providers and members
Blue Shield Promise assists you in meeting health education state requirements by providing appropriate health education materials for you to distribute to your patients. These multilingual materials are available in the state-mandated topics.
Become a California Children's Services paneled provider
We encourage our network participants to become paneled providers for California Children's Services (CCS) so that children who can benefit from this program are able to see the providers they need.