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Back to June 2022 Stakeholder Communications Update

Quality Incentive Pool (QIP) Program Year (PY) 3.5 Evaluation

On April 29, DHCS submitted the QIP PY 3.5 evaluation report to CMS. In QIP, DHCS directs Medi-Cal MCPs to make performance-based quality incentive payments to participating public hospital systems based on performance on clinical quality measures. To receive QIP payments, hospital systems must achieve specified improvement targets, measured for all Medi-Cal beneficiaries using services. The six-month QIP PY 3.5 Program Year functioned as a transition to a new calendar year capitated rating period, which took effect on January 1, 2021 (QIP PY 4).  PY 3.5 marked changes to the QIP program, incorporating the District and Municipal Public Hospitals (DMPHs) as participating entities, in addition to the already-participating Designated Public Hospital (DPH) systems and adding Public Hospital Redesign and Incentives in Medi-Cal (PRIME) measures and funding into QIP. In PY 3.5, the measurement period and payment targets were modified with CMS' approval due to the COVID-19 PHE. An immunization sub-pool was added to incentivize QIP entities to improve immunization rates for calendar year 2020.

The PY 3.5 evaluation report showed that across all 17 DPHs, for the projects that DPHs were required to report, entities met their payment target on 48 percent of reported measures. The number of additional measures chosen by DPHs varied, and only four DPHs met all of their quality improvement targets for the measures chosen. Similarly to DPHs, the number of measures chosen by DMPHs varied, and only 15 percent (5 of 33) met all of their quality improvement targets for the measures chosen. Immunization measure rates varied widely for both DPHs and DMPHs. For more information about the DPH QIP program, visit the Directed Payments Quality Incentive Pool Program webpage.