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  • Quality Incentive Program

  • Affinity Health Plan’s 2019 Provider Quality Incentive Program (2019 QIP) includes key indicators for our primary care providers (PCPs). Affinity is offering the incentive program for all our lines of business – Medicaid/CHP/Essential Plan and Enriched Health (HARP).

    The 2019 QIP continues to address the following corporate quality goals:

    • To ensure the QIP is aligned with Affinity’s HEDIS®/QARR goals;
    • To maximize Affinity’s potential to improve year-over-year performance in a cost-effective manner, and;
    • To ensure that the right measures and stakeholders are appropriately and effectively rewarded for meeting and exceeding Affinity-defined benchmarks.

    QIP Provider Eligibility Requirements

    • Provider must have an active Provider Portal account.
    • Provider must have electronic medical records.
    • Provider must be able to exchange data electronically with Affinity (e.g., supplemental data submissions, HL7 data exchange, etc.).
    • Medicaid/CHP/Essential Plan:

      • Provider must have a minimum of 500 combined Medicaid/CHP/EP members in their panel and at least 10 members within a given measure’s eligible population.

      Enriched Health (HARP):

      • Provider must have a minimum of 50 HARP members in their panel and at least 10 members within a given measure’s eligible population.

    What’s New to the 2019 QIP

    Three new measures have been added to this year’s Incentive Program:

    • Statin Therapy for Patients with Cardiovascular Disease (Statin Adherence 80%)
    • Comprehensive Diabetes Care: Eye Exam*
    • Comprehensive Diabetes Care: HbA1c Poor Control
    • The Annual Dental Visit measure has been removed from this year’s Incentive Program.

    * Removed from the Comprehensive Diabetes Care composite measure; it will be incentivized as a standalone measure.

    Bonus Payout Structure

    For all QIP measures, the potential bonus amount is $100 per compliant member for target HEDIS® rates obtained.

    The sample below illustrates how that would be calculated:

    Practice A has 1,200 combined Medicaid/Child Health Plus/Essential Plan members. Of that membership, 200 were eligible for the colorectal cancer screening measure. A total of 130 members met the measurement.

    • Target: 64.23%
    • Denominator: 200
    • Numerator: 130
    • Percentage: 65% (Target Met/Exceeded)

    Payout is earned and calculated as 130 compliant members X $100 per member = $13,000 for that measure.

    An updated 2019 QIP Manual will be available in June; however, the 2019 QIP report cards and gaps-in-care lists are already available on the Affinity Provider Portal for your convenience and continued patient outreach.

    QIP Measures
    Click here to view measures, incentive award amount and target rate for Medicaid/CHP/Essential Plan.
    Click here to view measures, incentive award amount and target rate for HARP.