Blue Shield of California Promise Health Plan’s Provider Incentive Program is designed for our network physician practices and Independent Physician Associations (IPAs) who provide healthcare services for our valued Medi-Cal plan members.

The goal of the program is to encourage healthcare providers to ensure that our members receive the kind of care that all of us, including providers, would want our own family and friends to receive. This should result in high quality, efficient health care that is sustainable through reduction of overall healthcare spending costs.

We offer four types of incentives to network participants, based on provider organization type and location.

Incentive program for primary care physicians

Patient-Centered Medical Home Certification

This program is available to primary care physician practices throughout California. Any primary care physician practice that is Patient-Centered Medical Home (PCMH) certified by the National Coalition of Quality Assurance (NCQA) or Joint Commission is eligible to participate in this incentive program. Only those locations which are PCMH-certified are eligible. The practice must sign an attestation confirming which of their locations are PCMH-certified.

The incentive is calculated on a per member, per month (PMPM) basis and is paid twice a year, in April and October. The April payment reflects incentives earned for November of the previous year through April of the year in which the payment is made. The October payment reflects incentives earned for the period of May through October in the same year that the payment is made.

Read program overview (PDF, 310 KB)

Incentive programs for IPAs

Value Incentive Program for Los Angeles County (VIP LA)

Blue Shield Promise wants to recognize top-performing IPAs in Los Angeles County by providing an additional incentive on top of L.A Care's VIP incentive.

A score is calculated annually, based on five domains:

  • Access and availability
  • HEDIS
  • Member satisfaction
  • Utilization
  • Encounter timeliness

L.A. Care and Blue Shield Promise's own data sources provide the data. The score for each measure in a domain is based on how the IPA's result compares to its peers. If the IPA is in the 90th percentile or above, it receives the full points. If it's between the 50th and 89th percentile, they receive 50% of the points. If it's below the 50th percentile, the IPA doesn't receive points for that measure. The Encounter gate incentivizes IPA's to increase their encounter data submission. As provider groups reach higher levels of encounter data submission, they are eligible for a larger percentage of their total possible incentive payment.

The VIP LA incentive will be paid during June in the year that follows LA Care's incentive payment. For example, for Measurement Year (MY) 2018, LA Care's incentive will be paid in the fourth quarter (Q4) of 2019; Blue Shield Promise's VIP LA incentive payment for MY 2018 will be paid in June 2020.

Read program overview (PDF, 72 KB)

Value Incentive Program for San Diego County (VIP SD)

Blue Shield Promise has created the Value Incentive Program for San Diego County (VIP SD). VIP SD is modeled after L.A. Care's VIP. By evaluating certain measures and sharing best practices with IPAs, Blue Shield Promise will reward top performing IPAs with the goal of encouraging higher quality in provided services, in all of our network IPAs. This is intended to help us ensure the best possible care for our San Diego County members.

A score is calculated based on five domains:

  • Access and availability
  • HEDIS
  • Member satisfaction
  • Utilization
  • Encounter timeliness

Data is provided from Promise Health Plan's own data sources. The score for each measure in a domain is based on how the IPA's result compares to its peers. If it's in the 90th percentile or above, the IPA receives the full points. If it's between the 50th and 89th percentile, they receive 50% of the points. If it's below the 50th percentile, they don't receive points for that measure. The Encounter gate incentivizes IPAs to increase their encounter data submission. As provider groups reach higher levels of encounter data submission, they are eligible for a larger percentage of their total possible incentive payment.

NOTE: For MY 2018, VIP SD will have a simplified domain score composed of only three Domains: HEDIS, Utilization, and Encounter timeliness. Access and availability and Member satisfaction will not be included in MY 2018.

Blue Shield Promise Health Plan will pay its VIP SD incentive in June of the year following the year that an MY has closed. For example, MY 2018 VIP SD measurement data will be finalized at the end of Q4 in 2019, and payment will be made in June 2020.

Read program overview (PDF, 72 KB)

Integrated Healthcare Association’s Align.Measure.Perform (AMP) for Medi-Cal Managed Care

Integrated Healthcare Association’s (IHA's) Align.Measure.Perform. (AMP) Medi-Cal Managed Care Program is based on a common set of measures and benchmarks spanning clinical quality, patient experience, utilization, and cost-of-care measures. This program is available to all network IPAs. The program collects data and calculates performance results for IPAs and other types of organizations that provide care to Medi-Cal managed care enrollees.

IPAs must choose to participate in IHA’s AMP program for Medi-Cal Managed Care. Blue Shield Promise uses the AMP program scores to calculate an incentive payment, which pays annually in December of the following year. The MY 2018 pays in December 2019.

Read program overview (PDF, 391 KB)
Find more information

Additional AMP resources

View presentations or watch recorded webinars that IHA facilitated and Blue Shield Promise hosted.

Introduction to IHA's AMP
Webinar slides (PDF, 967 KB)

Introduction to IHA Measure Sets
Webinar slides (PDF, 1.1 MB)
Recorded webinar

Data collection and participation timeline
Webinar slides (PDF, 1.1 MB)
Recorded webinar


If you have any questions about the Medi-Cal Provider Incentive Program, we are here to assist you. Please email us at ProviderIncentives@blueshieldca.com.