2022-04: PMPM Quality Incentive Program Launching on April 1, 2022
Date: 02/18/22
Beginning April 1, 2022 our Per Member Per Month (PMPM) quality incentive program for our in-network primary care providers will be updated to align with the Louisiana Department of Health quality measure priorities.
The PMPM incentive amount remains unchanged. As a valued primary care provider in our network, you will still be eligible for the same earnings amount based on the following performance criteria:
- Performance measure results will be determined using administrative claims data
- Data will be calculated after a 90-day claims lag (i.e., January data is evaluated in May)
- To be eligible for performance based PMPM, a practice must meet or exceed the established performance goal in the month being evaluated.
2020 Money Measures | Description | 2022 Target |
WCV Is reported as a single/total rate as well as the sub-measures | WCV – well visits for 3- 21 yrs) | 48.65 |
W30 Only reported as the sub-measures – not a combined. | (0-15 months) | 53.77 |
(15-30 months) | 70.24 | |
CIS Combo 3 | Childhood Immunization Status | 71.86 |
IMA Combo 2 | Immunization for Adolescents | |
CDC A1C Poor Control** >9.0 *Inverse measure – lower rate is better | Comprehensive Diabetes Care A1C Poor Control >9.0 |
41.93 |
CDC Eye Exam | Comprehensive Diabetes Care - Eye exam | 60.91 |
| AAP | Adult Access/ Preventive Care | 79.03 |
| SPD | Statin Diabetes (Adherence) | 59.88 |
| CBP | Controlling Blood Pressure | 50.55 |
** The Diabetes HgA1C>9 measure (Poor Control) is an inverse measure in which a lower rate indicates better clinical care or control. LHCC is adjusting the measurement and associated target to better align our shared performance goals towards a positive or upward improvement threshold. This adjustment is intended to standardize the scorecard and simplify interpretation of progress as all measures will have a benchmark that should be exceeded. (Higher percentage reflects better performance.)
Please note: Only measures for which you have at least 25 eligible patients will apply to your incentive calculation. All Incentive measures and codes have not changed from 2020.
Incentives will take effect on April 1, 2022. As a valued provider in our network, you do not need to do anything to participate in this incentive program.
For questions or additional support, please contact your dedicated Provider Network Specialist or call Provider Services at 1-866-595-8133.