Quality Enhancement Program (QEP)

Primary care provider QEP guide effective October 1, 2021 (PDF)

Primary care provider QEP guide (Effective through June 30, 2020) (PDF)

Primary care provider QEP guide (Effective July 1, 2020) (PDF)

Perinatal QEP guide (PDF) (Effective through June 30, 2020)

Perinatal QEP guide (Effective July 1, 2020) (PDF)

 

What is the QEP?

  • The QEP is an enhanced incentive program designed to reward higher performance by practices that meet financial and quality benchmarks by reducing unnecessary costs and delivering quality health care for our members. The QEP became effective on July 1, 2014. The quality measures represent a comprehensive patient quality model covering availability of care, use of services, and preventive screenings. The incentive payment is based upon a total cost of care risk-adjusted shared savings model. 
  • The five performance components include: 
  1. Quality performance. 
  2. Severity of illness. 
  3. Utilization management.
  4. Patient-centered medical homes.
  5. Access to provider's electronic health records (EHRs).

Who can qualify for the QEP?

PCP practices with panel sizes of 100 or more continuously enrolled AmeriHealth Caritas Louisiana members are eligible for participation in this program.

How is the performance measured?

  • Performance is based on the Actual versus Expected medical and pharmacy costs of the members attributed to the practice reflecting Efficient Use of Services (actual medical and pharmacy costs less than the expected medical and pharmacy costs in the measurement period). Once the Efficient Use of Services component is met, practices are eligible for incentive compensation.
  • The quality performance component is based upon how well a PCP office scores on each incentive component relative to the National Committee for Quality Assurance (NCQA) Quality Compass percentiles and are paid by performance tiers.
  • Provider performance is documented on a report card in each reporting period.

How often is this incentive paid?

  • The incentive is paid quarterly to qualifying practices following the calculation of that quarter’s settlement results.

Why does AmeriHealth Caritas Louisiana have a QEP?

  • Improving the health outcomes of our members lies in the strength of our collaboration with our PCPs.
  • We believe that aligning financial incentives and providing you with actionable data will enable us to develop a stronger provider partnership and improve the quality of care our members receive.

What kind of resources can I expect to receive with the QEP?

Your area network management account executive can familiarize you with the program overview and provide additional training to you and your staff.

  • When your patient arrives for services, your front desk staff can print individualized patient reports via NaviNet while checking member eligibility. The staff can attach the reports to the patient's chart so you will be aware of the needed services. Access a NaviNet user guide  (PDF).
  • This NaviNet dashboard tool provides actionable data that allows you to identify your linked members and services that they may need — referred to as the care gap.
  • If you have questions related to the calculations and clinical measures, our network management team can assist.
  • AmeriHealth Caritas Louisiana offers a HEDIS® coding resource guide to ensure that you are billing appropriately for services. This will ensure your practice receives credit for services rendered and your scores reflect the correct calculation bases upon the services rendered.
  • Your area network management account executive is available to you for any questions or training for you and your staff.