What's New for the Care-Based Incentive Program

What's New for CBI 2024

Central California Alliance for Health’s CBI Program comprises a set of measures encouraging preventive health services and connecting Medi-Cal members with their primary care providers (PCPs). The program offers financial incentives and technical assistance to support providers in helping members self-manage their care and reduce proximal health care costs. The CBI Program pays qualifying contracted provider sites, including family practice, pediatrics, and internal medicine. Provider incentives are broken into:

• Programmatic measures that are paid annually based on rate of performance in each measure.
• Fee-for-service (FFS) measures that are paid quarterly when a specific service is performed, or a measure is achieved.

New Programmatic Measures:

Lead Screening in Children: This measure was moved from exploratory to a programmatic measure and 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.

New Fee-For-Service (FFS) Measures:

• Diagnostic Accuracy and Completeness Training: The plan shall pay providers, including mid-level providers and second- and third-year residents, for completing the CMS web-based training course for Diagnostic Coding: Using the ICD-10-CM training.
• Cognitive Health Assessment Training and Attestation: The plan shall pay providers, including mid-level providers and second- and third-year residents, for completing the DHCS cognitive health assessment training and attestation.
• Social Determinants of Health (SDOH) ICD-10 Z-Code Submission: The plan shall pay clinics who submit DHCS priority SDOH Z-codes.
• Quality Performance Improvement Projects: The plan shall pay clinics that participate in an Alliance offered Quality Performance Improvement Only offices with metrics that are below the minimum performance level, measured at the 50th percentile for the 2023-year programmatic payment are eligible for payment for completion of Quality Performance Improvement  Projects.

Measure Changes:

• Initial Health Assessment has been changed to Initial Health Appointment.
• Screening for Depression and Follow-up Plan has been changed to Depression Screening for Adolescents and Adults. This measure looks at the percentage of members 12 years of age and older who were screened for clinical depression using a standardized tool.
• Health Equity Measure: This is a health plan performance measure, using the Child and Adolescent Well-Care Visit measure. Points will be awarded if well-child visit rates are improved for all ethnicities.

Retired Measures:

• Body Mass Index (BMI) Assessment: Children & Adolescent
• Immunizations: Adults

New Exploratory Measures:

• Well-Child Visits for Age 15 Months – 30 Months: This measure looks at the percentage of members ages 30 months old who had 2 or more well-visits with a PCP during 15-30 months of life.

New Programmatic Payment Methodology

• Removed programmatic payment based on comparison group pools
• Assigned a maximum practice programmatic payment based on member months
• Removed the Quality of Care Performance payment adjustment
• Removed the risk stratification score
• Updated point calculation for Quality of Care and Care Coordination measures