Provider Incentives
Click here for 2021 Care-Based Incentives forms and other helpful resources.
Care-Based Incentives
The successful Care-Based Incentive (CBI) program for PCPs is in its seventh year. The CBI Program incorporates feedback from a variety of sources, such as provider surveys, Physician Advisory Group and other committees, evaluation of the CBI program, and input from the Alliance Board. The CBI Program incentivizes the Alliance's provider network with the following goals:
- Improve quality outcomes, as reflected in part by Healthcare Effectiveness Data and Information Set (HEDIS) scores
- Improve member experience
- Encourage delivery of high value care
- Improve patient access to primary care
- Encourage use of disease registries to address population health
- Encourage adoption of best-practice care guidelines as recommended by U.S. Preventive Services Task Force (USPSTF)
- Reduce disparities in quality or service delivery between groups of members and/or geographic regions
For more information on the CBI Program, please see Section 18 of the Alliance Provider Manual.
Specialty Care Incentives (SCI)
The Specialty Care Incentive (SCI) program compensates participating referral providers for offering Alliance Medi-Cal members access to certain specialty medical services. The program is designed to improve member access to specialty care services and encourage specialty care physician participation in the Alliance's Medi-Cal program.
For additional information on the SCI program, please see Section 18 of the Alliance Provider Manual.
Value Based Payment (VBP)
The Department of Health Care Services (DHCS) has proposed a Value Based Payment (VBP) Program through Medi-Cal Managed Care Health plans that will provide incentive payments to qualifying providers for meeting specific measures aimed at improving care for certain high-cost or high-need populations. To address and consider health disparities, an increased payment has been allocated for members diagnosed with substance use disorder, serious mental illness, or homeless or inadequate housing.
Metrics target areas such as:
• Behavioral health integration
• Chronic disease management
• Prenatal/post-partum care
• Early childhood prevention
For additional information on VBP program, please see the DHCS VBP website and Alliance Provider News update.
