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Updates to the Provider Incentive Program
Attention: Primary Care Providers
Effective Date: August 2020
Texas Children’s Health Plan would like to thank you for the dedication and care you continually provide to our valued members. We appreciate all your effort in improving the quality of care our members receive every day. Our HEDIS metrics are just one way we see that outcome, and it is reflected in our provider incentive program (PIP) results. We would like to share an update made to our PIP because of your feedback. We value your partnership and take your comments seriously. You have provided meaningful input on this program and we have implemented enhancements accordingly. How this impacts providers: As of August 2020, we are modifying the member attribution algorithm to a provider for the purposes of calculating the HEDIS scores for the incentive programs. Previous algorithm: Measured PCP performance based on members who were attributed to the PCP at the end of the HEDIS measurement period. Updated algorithm: Measure PCP performance based on the following member attribution logic
Providers will see this change in the incentive payment that is scheduled to be made August 2020. Next steps for providers: No action required. If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org. For access to all provider alerts, log into:www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
| Measure | Previous Algorithm | Updated Algorithm |
| W15-well-child visits in the first month of life (6 or more visits) | PCP at the end of the calendar year | The PCP at the end of the 15 month period for each member |
| IMA- Immunizations for Adolescents (Combination 2). The percentage of adolescents turning 13 who had the immunizations Meningococcal, Tdap and HPV. | PCP at the end of the calendar year | The PCP at the member’s 13th birthday |
| URI- Appropriate treatment for children with Upper Respiratory Infection (URI) | PCP at the end of June of each year | The PCP at the event date |