BQPP Reimbursement Levels: Level 1 - sign the Network Participation Agreement (standard fee schedule) ● Level 2 - 550 points needed ● Level 3 - 750 points needed ● The points are allocated in the following four categories (see table for details): PCMH Recognition = up to 250 points Improving Health Outcomes = 100 points Improving Patient Experience = up to 250 points Reducing Cost = up to 400 points Total Possible Achievable = 1000 points Category Program Measurement Components Points Assigned PCMH NCQA/JCAHO/URAC Patient-Centered Medical Home Level (1) - 150 points ● Recognition (PCMH), Physician Practice Connection (PPC) OR Level (2) - 200 points ● *Mandatory NCQA Patient-Centered Specialty Practice (PCSP) Level (3) - 250 points ● Recognition OR The Joint Commission Primary Care Medical Home (PCMH) which is equivalent to a NCQA PCMH level 3 Improving Quality Metrics 100 points for filling out the scorecard Health Internal & Family Med: Reporting only Outcomes Diabetes HbA1c poor control (hybrid/clinical) Diabetes HbA1c testing *Mandatory Nephropathy Test Breast Cancer screening Colorectal Cancer Screening Pediatrics: ADHD- follow up (initiation) ADHD- follow up (maintenance) Appropriate Testing for Children w/ Pharyngitis Appropriate Treatment for Children w/URI Improving Provider Quality Report (PQR): No points/ mandatory element Health The Blue Quality Physician Program will award points Outcomes to the practices that send their PQR Attestation to *Mandatory BCBSNC confirming that one practice staff and one provider have viewed the Provider Quality Report video training, accessed and reviewed the Provider Quality Report on Blue e. We encourage practices to utilize these reports to close care gaps.
BQPP Reimbursement Levels: ● Level 1 - sign the Network Participation Agreement (standard fee schedule) ● Level 2 - 550 points needed ● Level 3 - 750 points needed The points are allocated in the following four categories (see table for details): PCMH Recognition = up to 250 points Improving Health Outcomes = 100 points Improving Patient Experience = up to 250 points Reducing Cost = up to 400 points Total Possible Achievable = 1000 points Category Program Measurement Components Points Assigned PCMH Recognition *Mandatory NCQA/JCAHO/URAC Patient-Centered Medical Home (PCMH), Physician Practice Connection (PPC) OR NCQA Patient-Centered Specialty Practice (PCSP) Recognition OR The Joint Commission Primary Care Medical Home (PCMH) which is equivalent to a NCQA PCMH level 3 ● Level (1) - 150 points ● Level (2) - 200 points ● Level (3) - 250 points Improving Health Outcomes *Mandatory Quality Metrics Internal & Family Med: Diabetes HbA1c poor control (hybrid/clinical) Diabetes HbA1c testing Nephropathy Test Breast Cancer screening Colorectal Cancer Screening Pediatrics: ADHD- follow up (initiation) ADHD- follow up (maintenance) Appropriate Testing for Children w/ Pharyngitis Appropriate Treatment for Children w/URI 100 points for filling out the scorecard Reporting only Improving Health Outcomes *Mandatory Provider Quality Report (PQR): The Blue Quality Physician Program will award points to the practices that send their PQR Attestation to BCBSNC confirming that one practice staff and one provider have viewed the Provider Quality Report video training, accessed and reviewed the Provider Quality Report on Blue e. We encourage practices to utilize these reports to close care gaps. No points/ mandatory element
BQPP%202016%20Points%20Summary.docx