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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.
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
New Programmatic Measures:
- Alcohol Misuse Screening and Counseling has changed to Unhealthy Alcohol Use in Adolescents and Adults
- Application of Dental Fluoride Varnish
- Child and Adolescent Well-Care Visits
- Plan All-Cause Readmission replaced 30-Day Readmissions
Measure Changes:
- Preventable Emergency Visits: urgent visits count as half the value as an ED visit.
- Quality of Care measures eligible linked member requirement changed from > 5 to > 30 members
New Exploratory Measures (formerly Provisionary):
- Lead Screening in Children
- Tuberculosis (TB) Risk Assessment
Retired Measures:
- BMI Assessment: Adult
- Member Satisfaction
| Care Coordination Measures - Access Measures | ||||
|---|---|---|---|---|
| Measure | Summary Definition | Member Eligibility | Cov Kev Pab | Points Possible: 22.5 |
| 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. The IHA must include an age appropriate Staying Healthy Assessment (SHA) form. |
≥5 Linked Members continuously reenrolled within 120 days of enrollment (4 months) |
DHCS Staying Healthy Questionnaires (including English, Spanish and Hmong versions) DHCS MMCD Policy Letter No. 08-003 For a full list of codes see the IHA Tip Sheet. |
5 |
| 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 |
| Unhealthy Alcohol Use in Adolescents and Adults | Members 11 years and older who are screened for unhealthy alcohol use in primary care settings and providing persons 18 years and older engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use. | ≥5 Eligible Linked Members |
Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet Unhealthy Alcohol Use in Adolescents and Adults Codes: G0442, H0049, H0050, 88037-7 (Men), 75889- 6 (Women & Older Adults), 75624-7 AUDIT, 75626-2 AUDIT-C |
3 |
| Care Coordination Measures – Hospital and Outpatient Measures | ||||
| Measure | Summary Definition | Member Eligibility | Cov Kev Pab | Points Possible: 27.5 |
| 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 |
8 |
| 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 |
9 |
| Quality of Care Measures | ||||
| Measure | Summary Definition | Member Eligibility | Cov Kev Pab | Points Possible: 40 |
| Asthma Medication Ratio | Members 5-64 years of age who were identified as having persistent asthma and had a ratio of controller medication to total asthma medications of 0.50 or greater during the measurement year | ≥30 Eligible Linked Members |
Asthma Medication Ratio Tip Sheet ICD-10 codes indicating persistent asthma: J45.21 -J45.52, J45.901 - J45.909, J45.991 - J45.998 Mus saib CBI Technical Specifications for a list of asthma controller medications.
|
Varies |
| 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 - < 5th percentile Z68.52 - < 5th percentile to < 85th percentile Z68.53 – 85th percentile to <95th percentile Z68.54 - ≥ to 95th 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 |
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 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 Tdap - 90715 HPV – 90649, 90650, 90651 |
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); 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) |
≥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. G8510- Screening for depression is documented as negative, a follow-up plan is not required. |
Varies |
| Well-Child Visit 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 Visit 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, or Achieving a 5% improvement compared to the prior year. |
Measure specific member eligibility requirements | Programmatic Measure Benchmarks & Performance Improvement | 10 |
| Exploratory Measures | ||||
| Measure | Summary Definition | Member Eligibility | Cov Kev Pab | Points Possible |
| 90-Day Referral Completion | Completion rate of referrals from linked PCP to a specialist within 90 days. | ≥5 Eligible Linked Members | 90-Day Referral Completion Tip Sheet | N/A |
| Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents | The percentage of members ages 1-21 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 | N/A |
| 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 |
| Health Plan Health Disparity | This is a health plan performance measure, using the Child and Adolescent Well-Care Visit measure to determine whether different ethnic groups had los sis did not have equal access to primary care. | N/A | CBI Technical Specifications | 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 |
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 |
| Tuberculosis (TB) Risk Assessment | The percentage of members ages 12 months to 21 years (up to before their 21st birthday) who have been screened for latent tuberculosis infection (LTBI) risk factors by staff at the PCP office during the measurement year. | ≥5 Eligible Linked Members |
Tuberculosis (TB) Risk Assessment Tip Sheet TB Code: Z11.1 |
N/A |
| Practice Management Measures | ||
|---|---|---|
| Measure | Summary Definition | Cov Kev Pab |
| 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.
|
| 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 |
¹ The IHA incentive has a 15-month measurement period to accommodate 120 days post enrollment date. See CBI Technical Specifications for additional information.
|
Measure |
Summary Definition |
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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 >85th, 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) |
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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
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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.
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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
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Tus Xov Tooj Nug Kev Pab Los Ntawm Tus Kws Tu Neeg Mob (Nurse Advice Line) |
Members who call the Alliance Nurse Advice Line are eligible to be entered into a monthly raffle to win a $25 gift card. |
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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. |
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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. |
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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. |
*New measures in 2022
**Measure change in 2022
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Contact your Provider Relations Representative or call Provider Services at (800) 700-3874 ext. 5504
Cov lus nug?
Contact your Provider Relations Representative or call Provider Services at (800) 700-3874 ext. 5504
Hu Tuaj Rau Peb | Hu Dawb: 800-700-3874
