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 five types of incentives to network participants, based on provider organization type and location.
 

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 calculated on a per member, per month (PMPM) basis and is paid twice a year, in April and October. The April payment reflects incentives earned for November of the previous year through April of the year in which the payment is made. The October payment reflects incentives earned for the period of May through October in the same year that the payment is made.

For more information about this program, including an annual Program Description, please contact providerincentives@blueshieldca.com. 
 

Incentive programs for IPAs

Value Incentive Program for Los Angeles County (VIP LA)

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 (VIIP) incentive.

A score is calculated annually, based on various measurement domains including Clinical Quality measure through the Healthcare Effectiveness Data and Information Set (HEDIS). The score for each measure in a domain is based on how the IPA's result compares to its peers. If the IPA is in the 90th percentile or above, it receives the full points. If it's between the 50th and 89th percentile, they receive 50% of the points. If it's below the 50th percentile, the IPA doesn't receive points for that measure.

The VIP LA incentive will be paid during June in the year that follows LA Care's incentive payment. For example, for Measurement Year (MY) 2018, LA Care's incentive will be paid in the fourth quarter (Q4) of 2019; Blue Shield Promise's VIP LA incentive payment for MY 2018 will be paid in June 2020.

For more information about this program, including an annual Program Description, please contact providerincentives@blueshieldca.com. 

Value Incentive Program for San Diego County (VIP SD)

Blue Shield Promise independently operates the Value Incentive Program in San Diego County (VIP SD). VIP SD 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.

A score is calculated annually, based on various measurement domains including Clinical Quality measure through the Healthcare Effectiveness Data and Information Set (HEDIS). The score for each measure in a domain is based on how the IPA's result compares to its peers. If it's in the 90th percentile or above, the IPA receives the full points. If it's between the 50th and 89th percentile, they receive 50% of the points. If it's below the 50th percentile, they don't receive points for that measure.

Blue Shield Promise Health Plan will pay its VIP SD incentive in June of the year following the year that an MY has closed. For example, MY 2018 VIP SD measurement data will be finalized at the end of Q4 in 2019, and payment will be made in June 2020.

For more information about this program, including an annual Program Description, please contact providerincentives@blueshieldca.com.

Integrated Healthcare Association’s Align. Measure. Perform. (AMP) 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 network IPAs.

IPAs must choose to participate in IHA’s AMP program for Medi-Cal Managed Care. Blue Shield Promise uses the AMP program scores to calculate an incentive payment, which pays annually in December of the following year. For example, the MY 2018 pays in December 2019.

For more information about this program, please visit the IHA website or email providerincentives@blueshieldca.com.

Initial Health Assessment (IHA)

At Blue Shield Promise Health Plan (Blue Shield Promise), we are committed to providing high-quality care for our members and supportive services for the providers who deliver that care. That is why we are incentivizing our contracted provider network for performing Initial Health Assessments (IHAs) of new Medi-Cal enrollees to Promise Health Plan starting in Q2 of 2021. Our IHA provider incentive program rewards Blue Shield Promise network providers for ensuring that every member who requires an IHA receives the care they need.

The Department of Healthcare Services (DHCS) requires primary care providers to conduct an IHA for all new Medi-Cal members within 120 days of enrollment to Promise Health Plan. The IHA can be completed by a primary care physician (PCP), nurse practitioner (NP), certified nurse midwife (CNM), or physician assistant (PA).

Incentive payouts will be made to IPAs/medical groups every three months. A $50 payment will be made for every IHA completion demonstrated in Blue Shield Promise data systems via encounter data with a date of service within 120 days of the member’s enrollment at Promise Health Plan. A $25 payment will be made for every IHA completion demonstrated in Blue Shield Promise data systems via encounter data with a date of service greater than 121 days of the member’s enrollment at Promise Health Plan.

For more information about this program, including an annual Program Description, please contact providerincentives@blueshieldca.com.

Annual Wellness Exam (AWE) | In-Office Assessment (IOA) Program

At Blue Shield Promise, we are committed to providing quality care for our members. That’s why we are incentivizing medical groups and Independent Practice Associations (IPAs) who provide annual wellness exams for our Cal MediConnect members. Our Program rewards Blue Shield Promise network providers for ensuring their Cal MediConnect members receive an annual comprehensive health evaluation during their membership with Blue Shield Promise.

Incentive payouts are made to IPAs/medical groups every three months. Results must be documented in each patient’s Health Quality Patient Assessment Form (HQPAF) and returned within the required timeline to qualify for the incentive payment.

For more information about this program, including an annual Program Description, please contact providerincentives@blueshieldca.com. 
 

Additional resources

The Blue Shield Promise provider incentives team is here to serve you. Please contact us at providerincentives@blueshieldca.com for program resources and inquiries.