• Quality Incentive Program

  • Affinity Health Plan’s 2020 Provider Quality Incentive Program (2020 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 2020 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 2020 QIP

    • No changes from the 2019 QIP.

    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

    The 2020 QIP report cards and gaps-in-care lists will be available on the Affinity Provider Portal beginning July 2020 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.