CenCal Health’s provider incentive program supports quality of care for Medi-Cal members
On March 1 of 2022, CenCal Health launched the Quality Care Incentive Program (QCIP) to maximize the quality of care for its health plan members on the Central Coast. QCIP is a value-based incentive program that directly rewards plan providers who deliver exceptional medical care in their community. After nine months, the innovative initiative has resulted in a distribution of over $7 million in payments to participating primary care providers (PCPs). QCIP emphasizes the clinical priorities of significance to CenCal Health members, such as diabetes and asthma care, breast cancer and cervical cancer screenings, and child and adolescent well-care visits. In Santa Barbara and San Luis Obispo counties, CenCal Health is the Medi-Cal plan that partners with over 1,500 local physicians, hospitals and other providers in delivering patient care to more than 225,000 members. Medi-Cal is the name of California’s Medicaid benefits program; the federal government administers Medicaid.
Replacing five different incentive programs previously utilized, the single integrated QCIP more extensively supports PCPs to achieve excellence in quality care. Performance is measured monthly and follows pre-defined, industry-standard measurement specifications maintained by the National Committee for Quality Assurance (NCQA).
To promote health equity, QCIP payments are also tied to the diversity of member patients managed by each PCP; as such, payments increase to reflect the proportion of members of greater clinical complexity, for example, the aged or those disabled.
In July 2022, CenCal Health distributed over $3.5 million in QCIP payments to 85 eligible PCPs, marking the first payment for the recently launched pay-for-performance program. In October, the second payout – totaling $3,751,527 – was distributed to 86 PCPs in Santa Barbara and San Luis Obispo counties.
“QCIP is an innovative value-based incentive program,” said CenCal Health CEO Marina Owen. “As a community-based health plan, we are committed to supporting local providers through programs such as this one.”
In 2003, the Centers for Medicare & Medicaid Services established pay-for-performance initiatives to control healthcare costs and to increase access to care by encouraging more physicians to participate in Medicaid health plans. More recently, incentive programs have evolved to emphasize quality of care, especially the prevention and management of chronic conditions.
QCIP was designed to encourage increased utilization of evidence-based treatment, screening, and preventive health services. The program encompasses five clinical categories of care – Women’s Health, Pediatric Care, Behavioral Health, Respiratory Care, and Diabetes Care – using the most widely endorsed standard for quality measurement in managed care, the NCQA HEDIS® Volume 2 Technical Specifications.
To monitor progress, PCPs receive monthly performance reports and actionable gaps in care data through CenCal Health’s secure provider portal. No measures used in CenCal Health’s payment calculations encourage withholding of services. Payments are distributed quarterly.
To implement QCIP, CenCal Health’s quality management team, under the direction of Quality Officer Carlos Hernandez, collaborated with all internal departments at the local health plan, and external organizations such as the California Department of Health Care Services, as well as several representative primary care providers.
“This incentive program relies on longstanding commitment and participation from our primary care provider partners, which, I’m proud to report, is in abundance,” said Hernandez. “An exemplary example is Dr. Jeffrey Kaplan, who has demonstrated a track record of extraordinary QCIP performance. Dr. Kaplan’s performance was especially exceptional for pediatric preventive care well-child visits.”
Jeffrey S. Kaplan, MD is a pediatrician in Santa Maria, in practice for over two decades. “QCIP is unique, in that the incentives offered only promote increased use of services, aligned with widely accepted, evidence-based treatment recommendations,” said Kaplan.
More information on the Quality Care Incentive Program and CenCal Health is available at cencalhealth.org.
About CenCal Health
CenCal Health is the local Medi-Cal health plan that partners with over 1,500 local physicians, hospitals, and other providers in delivering health care services to over 225,000 members in its two-county service area – one in four residents of Santa Barbara County and one in five residents of San Luis Obispo County. Marking 40 years of serving the most vulnerable, CenCal Health prioritizes cultivating community partnerships; advancing quality and health equity; expanding its service role and reach in the community; and organizing for impact and effectiveness. With a vision to be a trusted leader in advancing health equity so that the communities we serve thrive and achieve optimal health, CenCal Health invites the public to review its 2023-2025 Strategic Plan at www.cencalhealth.org/strategicplan.
Media Contact: Sheri Mobley 213 509-9816 sheri@seamlesspr.com
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