Pay for Performance
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Manuals and Program Operations

IHA releases a P4P Manual for each measurement year. The manual includes technical measure specifications along with data collection and reporting guidelines. A final measure set, audit manual and data submission file layouts are also released for each measurement year.

Measurement Year 2016

Measurement Year 2015

Measurement Year 2014

Previous Measurement Years

Obsolete / Retired Codes

P4P follows NCQA standards for retiring and deleting obsolete measure specification codes.   Codes that have been deleted from the standardized code sets (e.g., CPT, ICD-9, HCPCS) are removed from P4P measure specifications after the look-back period plus one additional year has been exhausted.  This is explained in the General Guidelines of the P4P Manual, in a section titled Retiring Codes.

The document below includes codes that will be deleted from P4P over the next few years.  There are three tabs that indicate for which P4P Measurement Year the codes are scheduled to be deleted.

Because this list is generated at a point in time, it is subject to change. For example, if additional codes are removed from the standardized code sets in 2012, they may wind up on the 2014 list in the future (provided the look-back period for the measure plus one additional year is exhausted by 2014). In addition, if tables are reordered or deleted, then the table names in this document may become inaccurate for the other years.

P4P Obsolete / Retired Codes Document

HEDIS Compliance Audit Firms

The organizations and individuals that have been licensed by NCQA to conduct HEDIS Compliance Audits, including audits for Pay for Performance, can be found at the link below.

List of Certified HEDIS Compliance Auditors

List of Licensed Organizations for HEDIS Compliance Audits

Public Comment

IHA conducts a call for public comment prior to finalizing measures and specifications. The call for public comments is applicable to the following measurement year as well as modifications to the current measurement year. The public comment period is typically in September and October and the final P4P Manuals are released in mid-November.

2015 Call for Public Comment (posted September 1, 2015)

Appeals Process

In spite of a thorough validation and quality assurance process, it is possible for discrepancies to be found in the results in the Value Based P4P Preliminary Reports. Therefore, there is a formal appeals process for both physician organizations (POs) and health plans to appeal for changes. The appeals process occurs after the release of PO preliminary reports, which usually occurs in June of the reporting year.

MY 2014 Quality Appeals Process (Description) (posted June 1, 2015)

MY 2014 Quality Results Questions and Appeals Form (posted June 1, 2015)

Approved P4P Policies and Recommendations

The following P4P policies and recommendations have been approved by the P4P Steering Committee for use in California's P4P program:

2012 - 2015 P4P Measure Set Strategy

Value Based P4P Design (updated December 8, 2014)

Excellence in Healthcare Awards Methodology (posted March 18, 2015)

Excluding Patients who Decline Services

Linking P4P Payment Potential to Data Sharing

Handling Mergers and Acquisitions (posted March 21, 2011)

Standard Gain Sharing Methodology

Standard Payment Methodology (updated December 9, 2014)

Data Exchange

Standard Format for Registry Data Sharing DRAFT December 2009