2020 CPC+ and PCP Incentive Program manuals available

Our 2020 CPC+ and PCP Incentive Programs help support our joint efforts to deliver the right care, at the right time, in the right place and at the right price.

Review our draft 2020 manuals 

On these pages, you’ll find the following incentive information:

  • Care management incentive
  • CG CAHPS incentive
  • Excluding non-adherent members
  • Excluding patients by "special exception"

Print the new 2020 PCP+ and PIP manuals

Print and update your CPC+ and PIP program binder. We’ve outlined a brief description of changes below.

Overview of 2020 changes

Program measure grid (pg.6)

  • Changed values of several payouts
  • Added MTM measures

Program deadlines (pg. 13)

  • Medication therapy management
  • Medicaid Patient Centered Medical Home (PCMH)

Cervical cancer (pg. 25)

Updated to align with HEDIS. This year's emphasis is on cervical high-risk (hrHPV) testing.

Depression screening and follow-up (pgs. 31-33)

Dispensed and filled antidepressant medication on the same day as the first preventive E&M is considered numerator compliant.

Statin therapy for patients with diabetes (pg. 45)

  • Source and target source: switching from HEDIS statin therapy for patients with diabetes (SPD) definition to CMS 5-Star Part D Statin therapy in persons with diabetes (SUPD) definition for Medicare
  • Denominator:  Members 40-75 years old with at least two diabetes medications fill during the measurement period

New MTM measures:

  • Medication adherence for diabetes medications (pgs. 48-49)
  • Medication adherence for cholesterol (pgs. 50-51)
  • Medication adherence for hypertension (pgs. 52-53)

Medicare 5-Star challenge

  • Changed tier 1 and tier 2 target values for measures in the west/north region (pgs. 56-57)
  • Changed PMPM reward values for east region (pgs. 58-59)

Care management – (pgs. 60-64)

Adjusted PMPM values

Medication therapy management (MTM) (pgs. 65-66)

  • Added tier 3
  • Adjusted tiers, targets and payouts

Medicaid Patient Centered Medical Home (PCMH) recognition (pgs. 67-68)

The measure requires three components:

  • Component 1:  Active PCMH recognition
  • Component 2:  Health Information Exchange Participation with MiHIN
  • Component 3:  Care management engagement; practice must meet care management threshold

Risk adjustment (pgs. 70-71)

Measure requires two components:

  • Component 1:  Risk adjustment focus areas
  • Component 2:  Preventive care engagement (annual CPE)

New product line added: Medicaid

Healthy Michigan: Health Risk Assessment (pgs. 72-73)

Removed case definition statement "Members with coverage under the Healthy Michigan Plan that do not have a completed HRA within the past 11 months from the date of service (last attested HRA)."

Acute hospital utilization – (pg.74)

The measure will be finalized and released in the first quarter of 2020.

Emergency department utilization – (pg.75)

The measure will be finalized and released in the first quarter of 2020.