2022 PCP Quality Incentive Program highlights

The PCP Quality Incentive Program incents PCPs for high-quality performance in improving members’ health outcomes. For more information, please review the PQIP 2022 booklet found on the Provider portal here. Some highlights include:

• Lead screening has been added to the program but is not included in the commercial pediatric aggregate star rating. It will be treated as a stand-alone bonus measure.
• The Weight Assessment, Nutrition, and Physical Activity measures were removed from the OHIC aligned measure set and therefore removed from this program’s commercial pediatric measure set. It was replaced with Adolescent Well-Care Visits (ages 12-21).
• Comprehensive Diabetes Care – Nephropathy Screening has been removed from the Medicare measure set.
• To align with NCQA, Comprehensive Diabetes Care – Eye Exam and A1c Control measures have been renamed to “Eye Exam for Patients with Diabetes” and “Hemoglobin A1c Control for Patients with Diabetes (Medicare),” respectively.

New measure: Adolescent Well-Care Visits (WCV)

Adolescent Well-Care Visits

Measure definition – The percentage of members 12-21 years of age who had at least one comprehensive well-care visit with a PCP during the measurement year.

Age range – 12-21 years as of December 31 of the measurement year.

Codes that will close the Adolescent Well-Care Visits (WCV) gap in care

CPT – 99381-99385, 99391-99395, 99461

HCPCS – G0438, G0439, S0302, S0610, S0612, S0613

ICD-10 – Z00.00, Z00.01, Z00110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z01.411, Z01.419, Z02.5, Z76.1, Z76.2