The Department of Health Care Services implemented a managed care QIP in Designated Public Hospitals (DPH) beginning with the July 1, 2017, rating period. The Department directed Managed Care Plans to make QIP payments based on performance metrics in four strategic categories: primary care, specialty care, inpatient care, and resource utilization. The datasets include self-reported data on these metrics from DPH annual reports.

Quality Incentive Pool (QIP) Program Data (Year 1)

Quality Incentive Pool (QIP) Program Data (Years 1 - 5)

quality-incentive-pool-qip-program-data-years-1-5

Comprehensive Diabetes Care: A1C Control (<8%) (CDC-H8)

Comprehensive Diabetes Care: Eye Exam (CDC-E)

Comprehensive Diabetes Care: Blood Pressure Control (CDC-BP)

Asthma Medication Ratio (AMR)

Medication Reconciliation Post Discharge (MRP)

7 Day Post-Discharge Follow-Up for High Risk Beneficiaries

Children and Adolescent Access to PCP (CAP)

? 12-24 Months

? 25 Months-6 Years

? 7-11 Years

? 12-19 Years

Childhood Immunization Status (CIS) Combination 3

Immunization for Adolescents (IMA) Combination 2

Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy

Coronary Artery Disease (CAD): Antiplatelet Therapy

Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin-Receptor Blocker (ARB) Therapy - Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%)

Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)

Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin-Receptor Blocker (ARB) Therapy  for Left Ventricular Systolic Dysfunction

Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction

Surgical Site Infection (SSI) (Reported as SIR)

Perioperative Care: Selection of Prophylactic Antibiotic - 1st OR 2nd Generation Cephalosporin

Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis

Prevention of Central Venous Catheter (CVC) - Related Bloodstream Infections

Appropriate Treatment of Methicillin-Sensitive Staphylococcus Aureus (MSSA) Bacteremia

Stroke: Discharged on Antithrombotic Therapy (TJC STK-2)

Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Preoperative Evaluation in Low Risk Surgery Patients (QPP)

Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients 18 Years and Older

Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 2 to 17 years old

Unplanned Reoperation within the 30 Day Postoperative Period (QPP)

Concurrent Use of Opioids and Benzodiazepines

? RATE #1

? RATE #2

Quality Incentive Pool (QIP) Program Data (Year 1)

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