Monthly Clinical Pearl for Adult Primary Care Physicians

February 3, 2016

QCPI Clinical Quality Integration

2016 Measures

February 3, 2016

QCPI Clinical Quality Integration

2016 Measures

Each year, QCPI publishes the measures that will be utilized for its clinical programs. The following is a summary of our current processes and programs:

Clinical Quality Integration / Physician Quality Report (data collected from 2015-2016):

Clinical Quality Integration (CQI) is QCPI’s annual process which aligns clinical quality to core physician reimbursement. This pay-for-performance methodology furthers our goal of financially rewarding physicians for quality care of their patients through changes in physician reimbursement. Your group’s combined scores on QCPI’s clinical measures (as reported to you on a “Physician Quality Report”) provide you with your current quality of care ranking. Your group’s performance ranking against the network will also be listed. These annual rankings will help to determine your financial reimbursement in both the Blue Open Access and BlueChoice Healthcare Plan HMO/POS products. Physician Physician groups, after comparison to network peers, will be reviewed annually to receive a higher level of reimbursement, a lower level of reimbursement, or to remain on the same fee schedule. The 2016 CQI metrics are posted at www.qcpi.org and may be viewed by visiting this URL: http://www.qcpi.org/incentive-programs/clinical-quality-integration/

Please note that the Technology Use measures are also outlined in the CQI measures grid and will be included in the Physician Quality Report.

Recognize and Reward Programs:

The purpose of these programs is to give incentives to physicians to provide documented, measurable preventive care to their patients. The 2016 measures are indicated with a check mark under the column “Recognize and Reward Program” on the 2016 CQI metrics grid posted at www.qcpi.org and may be viewed by visiting this URL: http://www.qcpi.org/incentive-programs/clinical-quality-integration/

Please note that your performance in these programs can impact your Physician Quality Report, so active participation is highly recommended. The Recognize and Reward programs are entirely discretionary, and all incentive payments made during any period are also subject to the availability of funds for that purpose.

NOTE: Please watch for additional communications about the 2016 Recognize and Reward programs.

We are respectful of your time and ask that you review the measures and administrative compliance criteria at your earliest convenience. If you have any questions about any of these programs, please call 678-553-4609 and ask for Sherry Vallee, LPN, Clinical Nurse Coordinator or contact her by email at .