NY Manual
SHP Manual

New York Provider Manual
16.2 Primary Care Services/Primary Care Providers | 16.4 Specialty Care and Specialists

16.3 The Healthfirst Quality Incentive Program (HQIP)

 
Healthfirst's mission is to provide the best possible quality and experience of care to our members.  We recognize the importance of the relationships providers have with their patients in achieving this goal.  To support providers in their efforts, Healthfirst established the Healthfirst Quality Incentive Program (HQIP), an annual program that incentivizes superior performance on select measures which are consistent with national and state-level benchmarks for quality of care. By achieving or surpassing the clinical performance goals set in HQIP, providers can earn quality incentive payments based on their Overall Quality Rating (OQR) and/or measure-specific rates/ratings. 
Participation in HQIP is limited to providers that take risk on Healthfirst members and/or meet membership thresholds determined by Healthfirst.  Healthfirst PCPs participating in our Medicaid, CHP, QHP, HARP, Medicare, Complete Care, and FIDA Plans may be eligible to earn quality incentive payments while delivering the superior healthcare and satisfaction to Healthfirst members that we all strive for. 
Healthfirst will share quality data and scoring, including OQR, with providers participating in HQIP on a monthly and quarterly basis.  If a provider participating in HQIP believes there are discrepancies or inaccuracies with their quality scoring, they may communicate this to Healthfirst through their Network Management Representative or Clinical Quality Manager.  If a provider would like to contest their Final HQIP results and/or OQR, they may do so by filing an appeal with Healthfirst.  To briefly summarize:
       Healthfirst will accept appeals after HQIP Final Preview results are shared with providers.
       Providers must notify Healthfirst of their intention to appeal by sending an email to HQIP@healthfirst.org briefly outlining on what grounds they plan to appeal within ten (10) business days of Final Preview results being released by Healthfirst.  Providers must also (securely) provide any and all documentation supporting their appeal to HQIP@healthfirst.org within 10 business days of their initial written notification.
       Healthfirst will strive to make a formal decision within 45 business days of receiving a complete appeal proposal.  All appeal decisions will be reviewed and approved by Healthfirst's Executive Team, including the Chief Medical Officer.  Any decisions made by Healthfirst will be considered final and adjustments to final quality scoring and incentive earnings, if any, will be made accordingly. 
       Not all measures will be eligible for appeal and some appeals may be denied if the basis of the appeal does not meet the criteria outlined by Healthfirst. 
For more information about the Healthfirst Quality Incentive Program, email HQIP@healthfirst.org