Directed Payments Quality Incentive Pool Program

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Beginning with the State Fiscal Year (SFY) 2017-18 rating period, the Department will implement a managed care Designated Public Hospital (DPH) Quality Incentive Pool (QIP). The Department will direct Managed Care Plans (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 University of California (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.

MCPs, for any managed care questions regarding this program, please reach out the Hospital Directed Payment team PlanDP@dhcs.ca.gov.

Providers, for any managed care questions regarding this program, please reach out to the Hospital Directed Payment team at PublicDP@dhcs.ca.gov.

Program Authorities

Program Policies and Information

QPL-18-001 QIP PY 1 Reporting.pdf
QIP PY 1 Certification Form.pdf
QPL-18-002 Minimum Number of Cases.pdf (SUPERSEDED BYQPL-19-001; Please review QPL-19-001)
QIP Data Integrity Policy.pdf
QPL-19-001 Minimum Reporting Requirements.pdf (SUPERSEDES QPL-18-002)
QPL-19-002 QIP Measure Set PY 3 - This QPL informs all QIP Entities of the updated measure set and stratification requirements for PY 3 (July 1, 2019 – June 30, 2020).
QPL-19-003 PY 2 Reporting - This QPL provides PY 2 reporting instructions for the QIP program.
QPL-20-001 QIP PY 3Reporting and Payment Changes - This QPL informs all QIP Designated Public Hospitals and Health Systems (DPHs) of PY 3 (July 1, 2019 – June 30, 2020) reporting and payment changes for the QIP program.
QPL-21-001 QIP PY 3.5 Updates Due to COVID-19 - This QPL informs all QIP entities of the changes to PY 3.5 reporting and performance requirements.
QPL-21-002PY 3.5 PRIME Transition FluReporting - This QPL informs QIP Entities of necessary and required measurement and reporting instructions for the PRIME Transition measure1.3.3 – Preventative Care and Screening: Influenza Immunization.
QPL-21-003 Policy Information for DMPH Measure Survey and Community Partner Application
PY4 Program Policies
PY 4 General Guidelines for QIP Data Collection and Reporting
PY 4 Measure Set
PY 4 Participating Entities
QPL-21-005 - This QPL informs QIP entities and Medi-Cal Managed Care Health Plans of updates and clarifications for the PY 4 measure specifications for seven measures: Q-LBP, Q-URI, Q-AAB, Q-PCE, Q-FUA, Q-TRC, and Q-CCW.
QPL-21-006 - PY 4 Race and Ethnicity Stratification
QPL-21-007- Approved Community Partnerships for PY 4 and PY 5
QPL-22-002- PY 4 Updates
PY 5 Program Policies
QPL-22-003 - Data Auditing Policies
QPL-22-004 - Approved Community Partnerships for PY 5
PY 6 Program Policies
PY6 General Guidelines
QPL-23-001 - PY 5 and PY 6 Race and Ethnicity Stratification
QPL-23-002 - PY 5 Updates
QPL-23-003 - Approved Community Partnerships for PY 6
PY 5 Participating Entities
PY 6 Technical Update Addendum
QPL 24-001 PY6 Reporting Updates
QPL 24-002 Data Integrity Policy Revision
PY5 Measure Set
PY6 Measure Set
PY7 Measure Set
QPL 24-003 PY7 Reporting Updates
PY7 Program Policies
PY7 General Guidelines
QPL 24-004 QIP Policy Information for DMPH Measure Commitment Survey and Community Partner Application
QPL 24-005 Approved Community Partnerships for PY7
QPL 24-006 PY7 Q-DSF-E Reporting Update
QPL 24-007 QIP PY7 FUx Measures Updates
QPL 24-008 PY6 and PY7 Audit Update
QPL 24-009 QIP DMPH Funding Pool PY8 Onwards

Data Sharing

Data Sharing for the SFY 17-18 QIP Memorandum (9/10/2018)

QIP Value Sets by Measure for MCPs for DPH Reporting (9/18/2018)
QIP Reporting Manual PY1: for general guidance only (9/17/18)

QIP_PY2_Value Sets_by_Measure_for_MCPs_for_DPH_Reporting_04_04_2019.xls
QIP DATA SHARING FILE TEMPLATEv1.xls - This template is based on Inland Empire Health Plan’s (IEHP) PRIME Data Sharing File Template to provide IEHP’s County partners with PRIME data.
QIP_PY3_Value Sets_by_Measure_for_MCPs_for_DPH_Reporting
QIP-PY3.5-Value-Sets-by-Measure-for-MCPs-for-DPH-Reporting
QPL-20-002 Data Sharing (SUPERCEDED BY QPL-21-004)
QPL-21-004 Data Sharing (NEW-SUPERCEDES QPL-20-002)
QIP PY4 Value Sets by Measure for QIP Entity/MCP Data Sharing - MCPs should provide the minimum necessary data to QIP entities by April 30, 2022.
QPL-22-001 Data Sharing (SUPERCEDES QPL-21-004)
QIP PY5 Value Sets by Measure for QIP Entity/MCP Data Sharing -MCPs should provide the minimum necessary data to QIP entities by April 30, 2023.
QPL-22-005 Data Sharing (SUPERCEDES QPL-22-001)

QIP Evaluations

Contact Us

For more information, please contact the QIP team at qip@dhcs.ca.gov.

Last modified date: 7/17/2024 10:51 AM

​​​​​​​​​​​​​​Directed Payments Quality Incentive Pool Program

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