Blue Cross & Blue Shield of Rhode Island (BCBSRI) is committed to improving our members’ health (and the health of all Rhode Islanders) by supporting access to high-quality, cost-effective healthcare. Our continued investment to improve care quality emphasizes our plan to support primary care and limit fee-for-service rate increases.
A significant part of this commitment is our continued efforts to reward our network primary care providers (PCPs) for improving quality of care and for closing gaps in care, such as through our PCP Quality Incentive Program (PQIP). Our 2020 PQIP booklet—which outlines the programs and its measures—is now available.
Each year, BCBSRI is evaluated by a number of organizations—including the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA)—on the health outcomes of our members. We recognize that as a PCP, you have much more influence than we do in affecting improvement on many of the measures identified in the program, specifically those related to closing potential gaps in care. The 2020 PQIP is open to all PCPs, and includes measures for improving care for both Commercial and Medicare Advantage members.
We’ve listened to feedback from our providers from last year’s PQIP program and made some notable changes for 2020. Specifically we’re improving efforts to increase closure of gaps in care, and have aligned targets for measures for our Medicare Advantage population with the most current CMS Star Rating cut points. Commercial measures align with the most current NCQA Quality Compass percentile benchmarks.
We’ve also shifted our approach to incentive payments, basing them on a more holistic view that looks at an overall composite achievement score rather than measure-by-measure as in previous years. Also, the scoring methodology now includes a Star rating, helping you better understand your performance compared to your peers.
If you have questions about the 2020 PCP Quality Incentive Program, please contact PQIP@bcbsri.org. We look forward to working closely with you to continue improving healthcare quality and our members’ overall healthcare experience.