Directed Payments Quality Incentive Pool Program
Beginning with the July 1, 2017, rating period, the Department will implement a managed care DPH Quality Incentive Pool (QIP). The Department will direct MCPs to make QIP payments tied to performance on designated performance metrics in four strategic categories: primary care, specialty care, inpatient care, and resource utilization. The QIP payments will be linked to delivery of services under the MCP contracts and increase the amount of funding tied to quality outcomes. To receive QIP payments the DPH and UC systems must achieve specified improvement targets, which grow more difficult through year-over-year improvement or sustained high performance requirements. The total funding available for the QIP payments will be limited to a predetermined amount (pool).
Effective July 1, 2020, the Department has expanded the QIP program and added DMPHs.
Program Authorities
Program Policies and Information
- QPL-18-001 QIP PY 1 Reporting.pdf
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QIP PY 1 Certification Form.pdf
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QPL-18-002 Minimum Number of Cases.pdf (SUPERSEDED BY QPL-19-001; Please review QPL-19-001)
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QIP Data Integrity Policy.pdf
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QPL-19-001 Minimum Reporting Requirements.pdf (SUPERSEDES QPL-18-002)
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QPL-19-002 QIP Measure Set PY 3 - This QIP Policy Letter (QPL) informs all QIP Entities of the updated measure set and stratification requirements for Program Year (PY) 3 (July 1, 2019 – June 30, 2020).
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QPL-19-003 PY 2 Reporting- This QIP Policy Letter (QPL) provides Program Year (PY) 2 reporting instructions for the Quality Incentive Pool (QIP) program.
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QPL-20-001 QIP PY 3 Reporting and Payment Changes - This QIP Policy Letter (QPL) informs all QIP Designated Public Hospitals and Health Systems (DPHs) of Program Year (PY) 3 (July 1, 2019 – June 30, 2020) reporting and payment changes for the Quality Incentive Pool (QIP) program.
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QPL-21-001 QIP PY 3.5 Updates Due to COVID-19 - This QIP Policy Letter informs all QIP entities of the changes to PY 3.5 reporting and performance requirements.
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QPL-21-002 PY 3.5 PRIME Transition Flu Reporting - This QIP Policy Letter (QPL) informs QIP Entities of necessary and required measurement and reporting instructions for the PRIME Transition measure 1.3.3 – Preventative Care and Screening: Influenza Immunization.
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QPL-21-003 Policy Information for DMPH Measure Survey and Community Partner Application
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PY 4 Program Policies
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PY 4 General Guidelines for QIP Data Collection and Reporting
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PY 4 Measure Set
- PY 4 Participating
Entities
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QPL-21-005 - This QIP Policy Letter (QPL) informs QIP entities and Medi-Cal Managed Care Health Plans of updates and clarifications for the Program Year 4 (PY4) measure specifications for seven measures: Q-LBP, Q-URI, Q-AAB, Q-PCE, Q-FUA, Q-TRC, and Q-CCW.
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QPL-21-006 - PY 4 Race and Ethnicity Stratification
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QPL-21-007- Approved Community Partnerships for PY4 and PY5
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QPL-22-002- PY 4 Updates
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PY 5 Program Policies
Data Sharing
QIP Evaluations
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