The following guidelines apply to our Quality Incentive Program (QIP); participation in the program is voluntary.

We continue to collaborate with our contracted PCPs through our QIP, which offers financial incentives to reward providers who address Quality Rating System (QRS) gaps in patient care, resulting in improved health outcomes for our Individual on-exchange members. The QRS measures are used by the Centers for Medicare & Medicaid Services (CMS) to determine Star ratings for qualified health plans (QHPs). These Star ratings are designed to assist consumers who are selecting QHPs through an exchange.

See the tabs below for information about:

• Eligibility and payout
• Member attribution
• QRS gap closure
• Medicare QIP gap closure

The following tabbed guidelines apply to our 2024 Quality Incentive Program (QIP).

• Our Quality Measures Guide (PDF) provides more information on measure specifications and gap closure criteria.
• QIP program overview (PDF)

• Risk adjustment:
  Information about risk adjustment care gaps can now be accessed through the CGMA. These reports are available to illustrate the whole picture of the patient and empower each member’s care team with up-to-date information they need to provide the best quality care.

  • Risk adjustment care gap reports are available through the main menu in the top right-hand corner in the CGMA.
    * Note: Risk adjustment care gaps are accessible to offer additional insights to a patient’s health and wellbeing. We do not currently offer an incentive for closing risk adjustment care gaps.

We communicate with you about our QIP through our provider newsletter, Provider News. We share information about our products, quality initiatives and programs in our bi-monthly newsletter. Subscribe today.

Program questions: If you have questions about the incentive program, measure criteria, gap data submission requirements or EMR data extract specifications, please email us.

CGMA questions: If you have questions about using the CGMA, contact Novillus. Email.