Recognition for Quality Performance
Provider Type
- Physicians
- Participating Physician Groups (PPG)
Participating physician groups (PPGs) and directly contracted primary care physicians (PCPs) participating in the Ambetter HMO and Ambetter PPO may participate in a financial incentive program for improving quality of care as quantified by Healthcare Effectiveness Data and Information Set (HEDIS®) measures.
Incentives will be based on the following 4 HEDIS measures for care gap closure:
CODE | HEDIS MEASURE DESCRIPTION | SUB-MEASURE |
|---|---|---|
CBP | Controlling High Blood Pressure | |
HBD | Hemoglobin A1c Control for Patients with Diabetes | HbA1c Control (< 8.0%) |
COL | Colorectal Cancer Screening | |
CIS | Childhood immunization status | Combination 10 |
Incentives are calculated and paid out in November of the calendar year and a final payment for the full calendar year by the following August. The incentive program is not part of the compensation under the Health Net Provider Participation Agreement (PPA); it is supplemental compensation in addition to, but separate from, contracting rates. As such, Health Net reserves the right to alter the incentive program on an annual basis or to terminate it at any time by notifying the provider in writing of such termination.
Providers may contact their provider relations liaison or your provider network director for additional information about the incentive program.