2017 Care Based Incentives
For complete information on the Care Based Incentives (CBI) Program, please see Section 18 of the Alliance Provider Manual.
What's New for 2017
New Programmatic Measure
Diabetic HbA1c Good Control <8.0%: The Alliance will pay providers for diabetic members whose most recent HbA1c test is <8.0%.
New Fee-For-Service (FFS) Measures
Childhood Immunizations (Combo 3): $100 per member who has received the vaccinations noted below by their second birthday. This measure will be calculated using claims and registry data.
|4 DTaP||3 IPV|
|1 MMR||3 HiB|
|3 HepB||1 VZV|
Timely Prenatal Care: $25 per member for whom the provider has provided the member’s first prenatal visit by end of their thirteenth week of pregnancy or within 42 days of enrollment with the Alliance. This measure requires the provider to submit a Timely Prenatal Care form to the Alliance.
Annual Monitoring for Patients on Persistent Medications: $25 per member, 18 years and older, who has received ≥180 days of ACE/ARB or diuretics treatment, and has received serum potassium and serum creatinine tests.
Screening, Brief Intervention, and Referral to Treatment (SBIRT): $10 per initial screening and $10 per subsequent intervention (maximum of 4 per member per year). This measure will be calculated using claims.
Advance Care Planning: $25 per member per year for advance care planning sessions. This measure will be calculated using claims.
Additional Measure Changes
|•||Well Child (age 3-6), Well Adolescent (age 12-21) and Cervical Cancer Screenings will become both programmatic and FFS measures. In addition to annual programmatic payments, the Alliance will pay providers $25 per member per year for Well Child and Well Adolescent Visits and $25 per member/three years for Cervical Cancer Screenings.|
|•||Diabetic Testing for HbA1c and Diabetic Retinal Exam will become FFS measures in 2017. Providers will be incentivized $25 per screening completed, with a maximum of one screening/year.|
|•||Member reassignment threshold (for non-excused reassignments) has been changed to one reassignment annually per 150 linked members.|
|•||The Generic Prescription measure has been moved to a Performance Target measure. Providers who achieve 95% compliance will receive full points for this measure.|
|•||Programmatic - Quality of Care Measures|
|– Spirometry Test in the Assessment and Diagnosis of COPD|
|– Appropriate Testing for Children with Pharyngitis|
|– Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis|
|– Medical Attention for Nephropathy|
|– Medication Management Agreements|
|– Physician Orders for Life Sustaining Treatment (POLST)|