BQPP 2016: Points Allocation Summary

BQPP Reimbursement Levels:
● Level 1 - sign the Network Participation Agreement (standard fee schedule)
● Level 2- 550 points needed
● Level 3- 750 points needed

The points are allocated in the following four categories (see table for details):

  • PCMH Recognition = up to 250 points
  • Improving Health Outcomes = 100 points
  • Improving Patient Experience = up to 250 points
  • Reducing Cost = up to 400 points
  • Total Possible Achievable = 1000 points

Category

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Program Measurement Components

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Points Assigned

PCMH Recognition
*Mandatory / NCQA/JCAHO/URAC Patient-Centered Medical Home (PCMH), Physician Practice Connection (PPC) OR NCQA Patient-Centered Specialty Practice (PCSP) Recognition
OR
The Joint Commission Primary Care Medical Home (PCMH) which is equivalent to a NCQA PCMH level 3 / ● Level (1) - 150 points
● Level (2) - 200 points
● Level (3) - 250 points
Improving Health Outcomes
*Mandatory / Quality Metrics
Internal & Family Med:
Diabetes HbA1c poor control (hybrid/clinical)
Diabetes HbA1c testing
Nephropathy Test
Breast Cancer screening
Colorectal Cancer Screening
Pediatrics:
ADHD- follow up (initiation)
ADHD- follow up (maintenance)
Appropriate Testing for Children w/ Pharyngitis
Appropriate Treatment for Children w/URI / 100 points for filling out the scorecard
Reporting only
Improving Health Outcomes
*Mandatory / Provider Quality Report (PQR):
The Blue Quality Physician Program will award points to the practices that send their PQR Attestation to BCBSNC confirming that one practice staff and one provider have viewed the Provider Quality Report video training, accessed and reviewed the Provider Quality Report on Blue e.
We encourage practices to utilize these reports to close care gaps. / No points/ mandatory element
Improving Patient Experience / Advanced Care Team: Does your practice have 1 or 2 of the types of providers below:
  • Health Coach (RN, LPN, or MA)
  • PharmD or Pharm Tech
  • Physical Therapist or Occupational Therapist
  • LCSW or LPC
  • Psychologist/Psychiatrist
  • Nutritionist/Dietician
  • RN– Triage
  • Case manager/care coordinator (MA, RN, LPN, or CNA)
Practices may also achieve points if they have a co-management agreement in place with a behavioral health provider / Co-management agreement = 25 points
1 provider in the practice = 50 points
2 or more providers in the practice = 75 points
Improving Patient Experience / Patient Portal on practice website / 25 points
Improving Patient Experience / After Hours Care Weekdays (Hours after 5 pm and/or before 8 am )
and/or
After Hours Care Weekend
and/or
Co-Management Agreement with Urgent Care (for practices with 3 providers or less only) / Total 7 hours Weekday = 50 points
Total 4 hours on Sat or Sun= 50 points
Both weekday and weekend (7 hours for both) = 150 points
*3 providers or less, co-management agreementwith urgent care= 50 points
Reducing Cost / Practice Cost Report- Evaluation of the cost efficiency & utilization metrics of a practice in comparison to peer groups across North Carolina.
1 year action plan if practice is above 1.179 / Cost index at 1.0 or below = 250 points
1.0 -1.05= 200 points
1.06 - 1.10= 100 points
1.11 - 1.20= 50 points
Reducing Cost / Generic Prescribing-
Statewide Average: Target:
FM &GP - 83% 85%
IM- 82% 84%
OBGYN- 81% 84%
Peds- 76% 78% / At or above Target: 150 points
FP & GP: 80%- 84%= 100 points
IM: 79%- 83%= 100 points
OBGYN: 78%- 83%= 100 points
Peds: 72% - 77%= 100 points