Performance-Based Incentive Payment (PBIP)

PBIP predictive model and hybrid payment monitoring in Comprehensive Primary Care Plus (CPC+)

By Sam Masters John Kautter

The performance-based incentive payment (PBIP), a new payment model being piloted through Comprehensive Primary Care Plus (CPC+), is intended to focus practices’ attention on patient experience, clinical quality, and utilization measures that drive total cost of care.

The PBIP is paid prospectively in the first quarter of each year and is at-risk based on each practice’s performance during that year, as compared to annual benchmarks. This predictive simulation model allows the Centers for Medicare & Medicaid Services (CMS) to project how much money will be paid to practices in the coming year, allowing the agency to know how much money to request for the model. The Excel-based simulation incorporates five Electronic Clinical Quality Measures (eCQMs) and Merit-based Incentive Payment Systems (MIPS) and one Consumer Assessment of Healthcare Providers and Systems (CAHPS) score and uses historic data on these measures, number of attributed beneficiaries per practice, and normalization of each measure to more accurately know how much money to request for their model. The tool also allows the agency to adjust benchmarks (e.g., 50th percentile threshold to receive payment) to see how these policy changes would likely impact practice payments.

RTI’s role in designing and maintaining the tool allowed for real-time evaluation of benchmarks which supported proactive decision making for determining payments, and ensured that practices received accurate and timely payments.