CenCal Health Launches QCIP to Support Physician Excellence in Healthcare
To maximize the quality of care for its health plan members, CenCal Health has launched an innovative program named Quality Care Incentive Program or QCIP. Effective March 1, 2022, this pay-for-performance program aligns financial incentives to healthcare providers with excellence in clinical care of health plan members. CenCal Health is a Medi-Cal plan that partners with over 1,500 local physicians, hospitals and other providers in delivering patient care to more than 210,000 members in Santa Barbara and San Luis Obispo counties. Replacing five different incentive programs previously utilized, the single integrated QCIP will more extensively support primary care providers (PCPs) to achieve excellence in quality care. Medi-Cal is the name of California’s Medicaid benefits program; Medicaid is administered by the federal government.
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 place emphasis on quality of care, especially on prevention and management of chronic conditions.
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. Performance is measured monthly and in accordance with pre-defined, industry-standard, measurement specifications maintained by the National Committee for Quality Assurance (NCQA).
“We designed this incentive program to encourage increased utilization of evidence-based treatment, screening, and preventive health services,” said Carlos Hernandez, CenCal Health Quality Officer. “Performance is based on how often the standard of care is met. And no measures used in CenCal Health’s payment calculations encourage withholding of services.”
QCIP includes five measure domains, encompassing 13 clinical measures, as follows:
- Behavioral Health Care
Antidepressant Medication Management ‐ Acute Treatment
Antidepressant Medication Management ‐ Continuing Treatment
- Diabetes Care
Retinal Eye Exams
- Respiratory Care
Asthma Medication Ratio
- Women’s Health Care
Breast Cancer Screening
Cervical Cancer Screening
- Pediatric Care
Lead Screening in Children
Immunizations for Adolescents
Well Child Visits in the first 15 Months of Life
Well Child Visits in the first 30 Months of Life
Child & Adolescent Well‐Care visits
To develop and execute QCIP, CenCal Health’s quality management team, under the direction of Quality Officer Hernandez, collaborated with all internal departments at the local health plan, and external organizations such as the State of California Department of Health Care Services, as well as representative primary care providers. QCIP has already received positive reviews from PCPs for its comprehensive information and ease of use.
“The new Quality Care Incentive Program is an innovative step forward in CenCal Health’s strategy to ensure equitable health care for all,” said CenCal Health CEO Marina Owen. “QCIP reinforces our enduring partnership with providers, and meaningfully recognizes them. I am proud of CenCal Health’s commitment to eliminating health disparities through compassionate service.”
More information on CenCal Health is available at cencalhealth.org
About CenCal Health
CenCal Health is a community-accountable health plan that partners with over 1,500 local physicians, hospitals and other providers in delivering patient care to more than 210,000 members – about one in four residents of Santa Barbara County and one in five residents of San Luis Obispo County. A public agency, the health plan contributes approximately $50 million a month into the local economy, primarily through payments to healthcare providers who serve its membership. Established in 1983, it is the oldest managed care Medicaid plan of its kind in the nation. View its annual Community Report at cencal2021.org
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