Blue Shield of California Promise Health Plan’s provider incentive programs are designed for our network primary care practices and Independent Practice Associations (IPAs) in providing high-quality healthcare services to our valued Medi-Cal plan members.
The goal of each program is to encourage providers to ensure that our members receive high-quality care that is sustainably affordable. We offer incentives to network participants, based on provider organization type and location.
Incentive programs for IPAs
Promise Quality Performance Incentive (PQPI) for Los Angeles County
Blue Shield Promise recognizes top-performing IPAs in Los Angeles County through the Promise Quality Performance Incentive (PQPI) program. The incentive program focuses on Healthcare Effectiveness Data and Information Set (HEDIS) measures.
The PQPI LA incentive is paid in December after the close of the Measurement Year (MY). For example, the PQPI Program Measurement Year (MY) 2025 will be paid in December of 2026.
For more information about this program, including an annual Program Description, please contact providerincentives@blueshieldca.com.
Promise Quality Performance Incentive (PQPI) for San Diego County
Similarly, Blue Shield Promise recognizes top-performing IPAs in San Diego County through the Promise Quality Performance Incentive (PQPI) program. The incentive program focuses on Healthcare Effectiveness Data and Information Set (HEDIS) measures.
The PQPI SD incentive will also be paid in December after the close of the Measurement Year (MY). For example, the PQPI Program Measurement Year (MY) 2025 will be paid in December of 2026.
For more information about this program, including an annual Program Description, please contact providerincentives@blueshieldca.com.
Integrated Healthcare Association’s Align. Measure. Perform. (AMP) for Medi-Cal Managed Care
The 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 Blue Shield Promise network IPAs.
IPAs must confirm participation directly with IHA annually in order to be eligible for the AMP Medi-Cal Managed Care program. Blue Shield Promise uses the AMP program scores to calculate an incentive payment, which is paid annually, approximately three months after IHA releases final measurement year results.
To learn more information about this program, visit the IHA website or email providerincentives@blueshieldca.com.
Primary Care Access Program (PCAP)
At Blue Shield Promise we are committed to providing high-quality care for our members and supportive services for the providers who deliver that care. The Initial Health Appointment (IHA) and In-Office Assessment (IOA) are two processes that providers engage in to improve clinical and preventive health outcomes through access to primary care. The goal of these processes is to promote early detection as well as ongoing clinical assessment and treatment of our members with and without chronic conditions. We are pleased to reward Blue Shield Promise Medi-Cal network providers for ensuring that every member is seen and assessed in a timely manner.
The Department of Healthcare Services (DHCS) requires primary care providers to conduct an IHA for all new Medi-Cal members within 120 days of enrollment to a plan.
DHCS also requires access to primary care providers for existing members, ensuring members are assessed within a 12-month period. IOA submissions support this goal by rewarding our IPA/Medical Groups who ensure Blue Shield Promise members receive an annual comprehensive health evaluation during their plan membership with Blue Shield Promise.
Incentive payouts are made to IPAs/Medical Groups quarterly.
For more information about this program, including an annual Program Description, please contact providerincentives@blueshieldca.com.
Care Gap Closure Program(s)
Blue Shield Promise is pleased to periodically offer additional financial opportunities for medical groups and Independent Practice Associations (IPAs) for care given to Medi-Cal members during specific quarters of a Measurement Year (MY). Incentivized measures are quarter-specific and are selected by assessing the largest needs in preventive care throughout the Blue Shield Promise Medi-Cal network.
For more information about this program, including an annual Program Description, please contact providerincentives@blueshieldca.com.
Our Complex Case Management program allows us to work directly with members and collaborate closely with their physicians to coordinate care and services to high-risk members.
Blue Shield Promise behavioral health services cover mental health, substance use disorder, and autism spectrum disorder behavioral health treatment.
Our disease managment program provides education, care coordination, and support for members with certain chronic conditions.
Blue Shield Promise created a Quality Improvement Program (QIP) for all lines of business. This progrm allows us to identify opportunities for improvement of care and services to our members and providers.
Blue Shield Promise assists you in meeting health education state requirements by providing appropriate health education materials for you to distribute to your patients. These multilingual materials are available in the state-mandated topics.
We encourage our network participants to become paneled providers for California Children's Services (CCS) so that children who can benefit from this program are able to see the providers they need.
Get information about the Skilled Nursing Facility Workforce and Quality Incentive Program (SNF WQIP).