Care-Based Incentive (CBI) Summary

The Central California Alliance for Health’s Care-Based Incentive (CBI) program is comprised of a set of measures encouraging preventive health services and connecting Medi-Cal members with their primary care provider (PCP).

The CBI Program consists of Provider Incentives that are paid to qualifying contracted provider sites, including family practice, pediatrics and internal medicine. Provider incentives are broken into:

Programmatic measures which are paid annually based their rate of performance in each measure.
Fee-For-Service (FFS) measures which are paid quarterly when a specific service is performed, or a measure is achieved.

The Alliance also offers incentives to members through the Health and Wellness Rewards Program, which are paid directly to members. Members are eligible for these incentives if they are enrolled with Medi-Cal through the Alliance.

This incentive summary provides an overview the CBI program. For more information about provider incentive payments refer to the CBI Programmatic Measure Benchmarks & Performance Improvement and the Alliance Provider Manual. For additional information on the CBI Program, refer to the program year specific 2021 and 2022 CBI Technical Specifications. Additional information on member incentives can be found on the Member Incentives web page. For general questions, talk with your Provider Relations Representative.

2023 Summary of Changes

New Programmatic Measures:

Adverse Childhood Events (ACEs) Screening in Children and Adolescents has been moved from an exploratory to programmatic measure.
Health Equity is a new measure category, replacing the health plan health disparity exploratory measure.

Measure Changes:

Points from the Unhealthy Alcohol use in Adolescents and Adults have been redistributed to the Adverse Childhood Events (ACEs) Screening in Children and Adolescents.
Points from Ambulatory Care Sensitive Admissions (ACSA), Preventable Emergency Visits, Initial Health Assessment (IHA), and Quality of Care measure have been redistributed to the Health Equity measure.

New Exploratory Measure:

Colorectal Cancer Screening.

New Fee-For-Service (FFS) Measure:

Adverse Childhood Experiences (ACEs) Training and Attestation.

Retired Measures:

Unhealthy Alcohol Use in Adolescents and Adults.
Asthma Medication Ratio.
90-Day Referral Completion.
Tuberculosis (TB) Risk Assessment.

2022 Summary of Changes

New Programmatic Measures:

Breast Cancer Screening has been moved from an exploratory to programmatic measure.
Screening for Depression and Follow-Up Plan has replaced the Antidepressant Medication Management measure.

Measure Changes:

Plan All-Cause Readmission points have been redistributed to the Post-Discharge Care measure.
Points from Ambulatory Care Sensitive Conditions and Preventable Emergency Visits have been reallocated to the Quality of Care Measures.
The Joint Commission (TJC) PCMH certification has been removed from the Behavioral Health Integration FFS measure as a standalone qualification.

New Exploratory Measures:

Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents
Health Plan Health Disparity

Retired Measures:

Antidepressant Medication Management
Maternity Care: Postpartum
Maternity Care: Prenatal

Programmatic

Care Coordination Measures - Access Measures
Measure	Summary Definition	Member Eligibility	Cov Kev Pab	Points Possible: 21.5
Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents*	The percentage of members ages 1-20 years of age who are screened for Adverse Childhood Experiences (ACEs) annually using a standardized screening tool.	≥5 Eligible Linked Members	Adverse Childhood Experiences (ACEs) in Children and Adolescents Tip Sheet Screening codes: G9919 - Screening performed – results positive and provision of recommendations provided G9920 - Screening performed – results negative	3
Application of Dental Fluoride Varnish	The percentage of members ages 6 months to 5 years (up to or before their 6th birthday) who received at least one topical fluoride application by staff at the PCP office during the measurement year.	≥5 Eligible Linked Members	Application of Dental Fluoride Varnish Tip Sheet Fluoride Application Code: CPT 99188 CDT D1206	2
Developmental Screening in the First 3 Years	The percentage of members ages 1-3 years screened for risk of developmental, behavioral, and social delays using a standardized screening tool in the 12 months preceding or on their first, second, or third birthday.	≥5 Eligible Linked Members	Developmental Screening in the First 3 Years Tip Sheet Developmental Screening Code: 96110	2
Initial Health Assessment	New members that receive a comprehensive IHA within 120 days of enrollment with the Alliance. Note: For CBI 2022, the IHA must include an age-appropriate Staying Healthy Assessment (SHA) form per Department of Healthcare Services requirements. For CBI 2023 the SHA form is no longer required	≥5 Linked Members continuously reenrolled within 120 days of enrollment (4 months)	SHA Form Periodicity Schedule (CBI 2022 requirement only) DHCS Staying Healthy Questionnaires (including English, Spanish and Hmong versions) DHCS MMCD Policy Letter No. 08-003 DHCS MMCD Policy Letter 99-07 For a full list of codes see the IHA Tip Sheet.	4
Post-Discharge Care**	Members who receive a post- discharge visit within 14 days of discharge from a hospital inpatient stay. This measure pertains to acute hospital discharges only. Emergency room visits do not qualify.	≥5 Eligible Linked Members	Post-Discharge Codes: 99202-99215, 99241-99245, 99341- 99350, 99381-99385, 99391-99395, 99429	10.5
Care Coordination Measures – Hospital and Outpatient Measures
Measure	Summary Definition	Member Eligibility	Cov Kev Pab	Points Possible: 25.5
Ambulatory Care Sensitive Admissions**	The number of ambulatory care sensitive admissions (based upon Plan-identified AHRQ specifications) per 100 Eligible Members per year.	≥100 Eligible Linked Members	Ambulatory Care Sensitive Diagnosis For a full list of codes see the CBI Technical Specifications	7
Plan All-Cause Readmission**	The number of members 18 years of age and older with acute inpatient and observation stays during the measurement year that was followed by an unplanned acute readmission for any diagnosis within 30 days.	≥100 Eligible Linked Members	Plan All-Cause Readmission Tip Sheet For a full list of codes see the CBI Technical Specifications	10.5
Preventable Emergency Visits**	The rate of preventable ED and urgent visits per 1,000 members per year. Urgent Visits count as half the value as ED visits	≥100 Eligible Linked Members	Alliance Case Management and Care Coordination Programs Preventable Emergency Visits Tip Sheet Preventable Emergency Visit Diagnosis Tip Sheet	8
Quality of Care Measures
Measure	Summary Definition	Member Eligibility	Cov Kev Pab	Points Possible: 38
BMI Assessment: Children and Adolescents	The percentage of members 3 - 17 years of age who had an outpatient visit with a PCP or OB/GYN and had BMI percentile documented based on the CDC BMI-for-age growth charts.	≥30 Eligible Linked Members	Child and Adolescent BMI Assessment Tip Sheet Child & Adolescent BMI Assessment Codes: Z68.51 - < 5^th percentile Z68.52 - < 5^th percentile to < 85^th percentile Z68.53 – 85^th percentile to <95^th percentile Z68.54 - ≥ to 95^th percentile	Varies
Breast Cancer Screening	The percentage of women 50 – 74 years of age who had a mammogram to screen for breast cancer on or between October 1 two years prior to the Measurement Period and the end of the Measurement Period.	≥30 Eligible Linked Members	Breast Cancer Screening Tip Sheet Breast Cancer Screening Codes: 77061-77067 For a full list of codes see the CBI Technical Specifications	Varies
Cervical Cancer Screening	Women 21-64 years of age who were screened for cervical cancer using either of the following criteria: 21-64 years of age who had a cervical cytology performed within the last 3 years, beginning at age 21; or 30–64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last 5 years; or 30-64 years of age who had cervical cytology/HPV co-testing performed within the last 5 years	≥30 Eligible Linked Members	Cervical Cancer Screening Tip Sheet Cervical Cancer Screening Codes: Q0091 - using this code will ensure compliance obtaining, preparing and conveyance of cervical smear to a laboratory rather than relying on the lab to submit the claim. To exclude members from the measure: Z90.710 - absence of both cervix and uterus Z90.712 - absence of cervix with remaining uterus Q51.5 - agenesis and aplasia of cervix (Can be used for a male-to-female transgender person) For a full list of codes see the CBI Technical Specifications	Varies
Child and Adolescent Well-Care Visits (3-21 years)*	The percentage of members 3–21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.	≥30 Eligible Linked Members	Child and Adolescent Well-Care Visits Tip Sheet Well-Visit Codes: 99382-99385, 99392-99395, Z00.00-Z00.01, Z00.121-Z00.129, Z00.2-Z02.3, Z02.5, Z02.825, Z76.1, Z76.2	Varies
Diabetic HbA1c Poor Control >9.0%	Members age 18-75 who had a HbA1c test during the last 12 months, and whose most recent HbA1c test had result of >9.0%. Members with no lab result submitted will be considered non-compliant for this measure. (This is a reverse measure: lower rate is better)	≥30 Eligible Linked Members	Diabetic HbA1c Poor Control >9% Tip Sheet Health Education and Disease Management Programs HbA1c Test Codes: 83036, 83037 HbA1c Results: 3044F - 3046F, 3051F, 3052F	Varies
Immunizations: Adolescents	Adolescents turning 13 years of age who have received the following vaccinations by the time of their 13th birthday: 1 dose meningococcal conjugate 1 dose tetanus, diphtheria, and pertussis (Tdap) 2 doses of human papillomavirus (HPV)	≥30 Eligible Linked Members	Immunizations: Adolescents Tip Sheet Immunization Codes: Meningococcal – 90619, 90733, 90734, 428301000124106 (Anaphylaxis due to MCV vaccine) Tdap – 90715, 428281000124107, 428291000124105 (Anaphylaxis due to Tdap Vaccine), 192710009, 192711008, 192712001 (Encephalitis due to Tdap Vaccine) HPV – 90649, 90650, 90651, 428241000124101 (Anaphylaxis due to HPV vaccine)	Varies
Immunizations: Children (Combo 10)	Toddlers turning 2 years of age who have received all of the following vaccinations by on or by their 2nd birthday: 4 diphtheria, tetanus, acellular pertussis (DTaP) or history of anaphylaxis or encephalitis due to DTap vaccine; 3 inactivated polio vaccine (IPV); 1 measles, mumps and rubella (MMR) or history of measles, mumps and rubella illness.; 3 haemophilus influenza type B (HiB) or anaphylaxis due to the Hib vaccine; 3 hepatitis B (HepB) or anaphylaxis due to the Hepatitis B vaccine; 1 varicella (VZV) history of varicella zoster (e.g. chicken pox) illness.; 4 pneumococcal conjugate (PCV) 2 or 3 rotavirus (RV), or anaphylaxis due to the rotavirus vaccine; 1 hepatitis A (HepA), or history of hepatitis A illness; 2 influenza (flu)	≥30 Eligible Linked Members	Immunizations: Children (Combo 10) Tip Sheet For a full list of codes see the CBI Technical Specifications	Varies
Screening for Depression and Follow-up Plan	The percentage of members 18 to 64 years of age who are screened for depression on the date of the visit using an age-appropriate standardized depression screening tool, and if positive, a follow-up plan is documented on the date of the positive screen.	≥30 Eligible Linked Members	Screening for Depression and Follow-up Plan Tip Sheet Screening codes: G8431- Screening for depression is documented as being positive and a follow-up plan is documented. G8433 - Screening For Depression Not Completed, Documented Patient Or Medical Reason G8510- Screening for depression is documented as negative, a follow-up plan is not required.	Varies
Well-Child Visits in the First 15 Months	Members age 15 months old who had 6 or more well-child visits with a PCP during the first 15 months of life.	≥30 Eligible Linked Members	Well-Child Visits First 15 Months Tip Sheet Well-Child Visit Codes: 99381, 99382, 99391, 99392, 99461, Z00.110-Z00.129, Z00.2 Z02.5, Z76.1, Z76.2	Varies
Performance Target Measure
Measure	Summary Definition	Member Eligibility	Cov Kev Pab	Points Possible
Performance Improvement Measure	Providers can receive Performance Improvement points for every measure they qualify for by either: Meeting the Plan Goal, lossis Achieving a 5% improvement compared to the prior year.	Measure specific member eligibility requirements	Programmatic Measure Benchmarks & Performance Improvement	10
Health Equity Measure
Measure	Summary Definition	Member Eligibility	Cov Kev Pab	Points Possible
Health Equity*	This is a health plan performance measure, using the Child and Adolescent Well-Care Visit measure to determine whether different ethnic groups had lossis did not have equal access to primary care.	N/A	CBI Technical Specifications Child and Adolescent Well-Care Visits Tip Sheet Well-Visit Codes: 99382-99385, 99392-99395, Z00.00-Z00.01, Z00.121-Z00.129, Z01.411, Z01.419, Z00.2, Z00.3, Z02.5, Z76.1, Z76.2	5
Exploratory Measures
Measure	Summary Definition	Member Eligibility	Cov Kev Pab	Points Possible
Chlamydia Screening in Women	Women 16 to 24 years old who are identified as sexually active and who had at least one screening for chlamydia during the measurement year	≥30 Eligible Linked Members	Chlamydia Screening in Women Tip Sheet Chlamydia Screening Codes: 87110, 87270, 87320, 87490-87492, 87810	N/A
Controlling High Blood Pressure	Members 18–85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure was adequately controlled (140/90 mm Hg) in the last 12 months. BP reading must occur on or after the date of the second HTN diagnosis.	≥30 Eligible Linked Members	Controlling High Blood Pressure Tip Sheet Controlling High Blood Pressure Codes: 3074F, 3075F 3077F, 3078F, 3079F, 3080F	N/A
Colorectal Cancer Screening	The percentage of members 45–75 years of age who had appropriate screening for colorectal cancer. For Members 46-75 years use any of the following criteria: Fecal occult blood test within the last year. Flexible sigmoidoscopy within the last 5 years. Colonoscopy within the last 10 years. CT colonography within the last 5 years. Stool DNA (sDNA) with FIT test within the last 3 years.	≥30 Eligible Linked Members	Colorectal Cancer Screening Tip Sheet Fecal occult blood test CPT codes: 82270, 82274 Flexible sigmoidoscopy CPT codes: 45330-45350 Colonoscopy codes: CPT: 44388-44394, 44397, 44401-44408, 45355, 45378-45393, 45398 ICD-9: 45.22-45.23, 45.25, 45.42-45.43 CT colonography CPT codes: 74261-74263 Stool DNA (sDNA) with FIT CPT code: 81528	N/A
Immunizations: Adults	The percentage of members 19 - 65 years old who are up to date on influenza, TD/Tdap and zoster vaccines.	≥30 Eligible Linked Members	Immunizations: Adults Tip Sheet Adult Immunization Codes: Influenza- 90630, 90653-90654, 90662, 90673, 90674, 90682, 90686, 90688, 90689, 90694, 90756 Zoster- 90736, 90750 TDaP- 90714,90715, 428291000124105 (Anaphylaxis due to Tdap Vaccine), 192710009, 192711008, 192712001 (Encephalitis due to Tdap Vaccine)	N/A
Lead Screening in Children	The percentage of children 2 years of age who had one or more capillary or venous lead blood test for lead poisoning by their second birthday	≥30 Eligible Linked Members	Lead Screening in Children Tip Sheet Lead Screening Codes: 83655 For a full list of codes see the CBI Tech Specs.	N/A

Fee-for-Service

Practice Management Measures
Measure	Summary Definition	Cov Kev Pab
Adverse Childhood Experiences (ACEs) Training and Attestation	Plan shall pay providers, which includes mid-level providers, for completing the ACEs training and attestation. The plan will pay each CBI group $200 that the provider practices under.	$200 one-time payment Single time payment after receipt of State notification of training and attestation completion. Payments do not reoccur yearly or quarterly.
Patient Centered Medical Home (PCMH) Recognition	Plan shall pay a one-time payment of $2,500 to providers for achievement of NCQA recognition or The Joint Commission (TJC) certification. A copy of the recognition/ certification must be received by the Alliance. Payments do not reoccur yearly or quarterly.	For providers submitting their initial application for NCQA PCMH Recognition, use Alliance discount code CCAAHA to save 20% on your initial application fee. CBI Technical Specifications
Behavioral Health Integration	Plan shall pay a $1,000 one-time payment to providers for achievement of NCQA Distinction in Behavioral Health Integration. Payments are made a single time after distinction is received by the Alliance. Payments do not reoccur yearly or quarterly.	CBI Technical Specifications

CBI Timeline

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Measure	Summary Definition	Cov Kev Pab
Early Prenatal Care-Healthy Moms and Healthy Babies (HMHB) Program	Members who see their doctor within the first 13 weeks of being pregnant or 6 weeks of joining the Alliance, will be entered into a monthly raffle for a chance to win a $50 target gift card.	Breast Feeding Support and Breast Pump Benefit International Board-Certified Lactation Consultants and Breast Pump Vendor List Health Education and Disease Management Programs To refer members: Health Programs Referral Form - Central California Alliance for Health (thealliance.health)
Healthy Weight for Life (HWL)	Members between the ages of 2 to 18, with a BMI of >85^th, who attend a 10-week workshop will receive a target gift card for up to $100 for attending. Members who complete the workshop will also be entered into a quarterly raffle for a chance to win a bike.	Health Education and Disease Management Programs To refer members: Health Programs Referral Form - Central California Alliance for Health (thealliance.health)
Healthier Living Program Workshops	When members attend a 6-week workshop, that teaches skills to help manage chronic disease (nutrition, goal setting, and how to better communicate with providers and family members), they can receive a $50 gift card.	Health Education and Disease Management Programs To refer members: Health Programs Referral Form - Central California Alliance for Health (thealliance.health)
Immunizations: Adolescents	Adolescents members turning 13 years of age who have received the following vaccinations by the time of their 13th birthday, will be entered into a quarterly raffle for a $50 gift card. • 1 dose meningococcal conjugate • 1 dose tetanus, diphtheria, and pertussis (Tdap) • 2 doses of human papillomavirus (HPV)	** Measure requires provider to submit claims and update immunization registry Immunization Resource web page
Immunizations: Childhood Flu	Members between seven (7) and 24 months of age who have received two doses of the flu (influenza) immunization will be entered into a monthly raffle for a chance to win a $100 Target gift card. The raffle will run from November through July, corresponding with submitted flu season data (claims, DST, registry) from September through May.	**Measure required provider to submit claims and update immunization registry. Immunization Resource web page
Immunizations: Children	Toddler members turning 2 years of age who have received all of the following vaccinations by their 2nd birthday, will be entered into a quarterly raffle for a $100 gift card. 4 diphtheria, tetanus, acellular pertussis (DTaP); 3 inactivated polio vaccine (IPV); 1 measles, mumps and rubella (MMR); 3 haemophilus influenza type B (HiB); 3 hepatitis B (HepB); 1 varicella (VZV); 4 pneumococcal conjugate (PCV) 2 or 3 rotavirus (RV) 1 hepatitis A (HepA) 2 influenza (flu)	** Measure requires provider to submit claims and update immunization registry Immunization Resource web page
Kws Tu Mob Tus Xov Tooj Muab Lus Qhia	Members who call the Alliance Nurse Advice Line are eligible to be entered into a monthly raffle to win a $25 gift card.	Health Education and Disease Management Programs
Healthy Moms and Healthy Babies (HMHB) Program	Members who see their doctor 3 to 8 weeks after having a baby will receive a $25 target gift card.	Health Education and Disease Management Programs
Well-Child Visit First 15 Months of Life	Members age 15 months old who completed their well-child visit at: • 5 days old • 1 month old • 2 months old • 3 months old • 4 months old • 6 months old • 12 months old • 15 months old will be entered into a monthly raffle for a $25 gift card.	Health Education and Disease Management Programs
Well-Child Visit First 15 Months of Life	Members who completed 6 or more well-visits by 15 months of age will be eligible to be entered into a yearly raffle to win a $150 gift card.	Health Education and Disease Management Programs

*New measures in 2023
**Measure change in 2023

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Contact your Provider Relations Representative or call Provider Services at (800) 700-3874 ext. 5504

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Care-Based Incentive (CBI) Summary

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Lub Alliance

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