What's New for Care-Based Incentives
What's New for CBI 2021
To support providers during the COVID-19 Pandemic, telehealth services have been included in the following measures. In addition, the exclusion of telehealth services for well-visit measures has been removed.
Measure additions: telephone visit, e-visits, virtual check-in to event diagnosis.
- Antidepressant Medication Management.
- Asthma Medication Ratio.
- Diabetic HbA1c Poor Control.
- Maternity Care: Prenatal.
- Breast Cancer Screening.
- Controlling Blood Pressure.
New Programmatic Measures
New Exploratory Measures
These measures will not qualify for payment in 2021. They are being considered to be added as a paid measure in the 2021 CBI Program.
- Lead Screening in Children: Performance is based on children 2 years of age who had one or more capillary or venous lead blood test for lead poisoning by their second birthday.
- Tuberculosis (TB) Risk Assessment: Performance is based on the percentage of members 12 months to 21 years of age (up to before their 21st birthday) who have been screened for TB risk factors by staff at the PCP office during the measurement year.
- BMI Assessment: Adult.
- Member Satisfaction.
A payment adjustment has been added to the 2021 CBI program to align with State performance expectations for the Quality of Care Measures. Medi-Cal Plans must meet the 50th percentile for state reported metrics. If the health plan doesn’t meet the 50th percentile in one or more measures, they may be required to complete Plan, Do, Study Acts, (PDSAs); assigned a Corrective Action Plans (CAPs); or sanctioned (including financial penalty).
Payment will be adjusted for qualifying Quality of Care Measures where CBI Provider’s performance falls below the 50th percentile. The Quality of Care Performance adjustment will only apply to measures where a CBI Provider has a total of thirty (30) Eligible Members that qualify for the Measurement Component. For Quality of Care measures below the 50th percentile, payment will be adjusted as follows:
|Tier||Performance <50TH Percentile||CBI Programmatic Payment Adjustment|
|1||1-3 metrics >25th and <50th and no metrics <25th||CBI Programmatic Incentive Payment reduction of 25%|
|2||>4 metrics >25th and <50th and no metrics <25th||CBI Programmatic Incentive Payment reduction of 50%|
|3||1-3 metrics <25th||CBI Programmatic Incentive Payment reduction of 75%|
|4||4 or more metrics <25th||No CBI Programmatic Incentive Payment|