Value-Based Care Program Reminders

November 30, 2018
Value-Based Care Program Reminders

Thank you to our CPC+ and PCMH program participating providers for helping us improve healthcare! To complete our 2018 programs, please remember these points.

Care Plan Dates

  • Care plan dates must be submitted once every 6 months. 2018 dates must be submitted by January 31, 2019.
  • Care plans are required on at least 10% of the QualChoice population in your practice, starting with your highest risk members (Complex and Risk Tier 4). Care Plans for Risk Tier 1 members may not be included.
    • Multiple care plan dates may be submitted for each member.
    • A history of previous quarter plans can be accessed through the My Account

Quality Measures

A key element of our value-based care programs is the monitoring of quality data. We report data back to participating providers on 10 quality measures. Most data is generated from claims. However, you may have additional data that can improve your quality scores. Examples:

  • Medical records of a member who had a colonoscopy prior to enrollment with QualChoice.
  • Removal of a member who had a total hysterectomy from the cervical cancer screening measure.

Clinics must submit Category II CPT codes as eCQMs for these measures:

  • Controlling Blood Pressure
  • HbA1c Poor Control
  • Tobacco Use

To help improve your quality measure ratings, submit the Supplemental Data Submission Form, available on the My Account portal.

For Questions or More Information

For questions, email CPC+@qualchoice.com or PCMH@qualchoice.com.

Learn more about QualChoice value-based care programs.

;