Quality Care Incentive Program
CenCal Health’s Quality Care Incentive Program (QCIP) identifies members who are due for clinically recommended services to help Primary Care Providers (PCPs) continue providing high quality health care for members. Providers can contact CenCal Heath’s Quality Department for more information at: qcip@cencalhealth.org
CenCal Health’s QCIP quality measures encompass aspects of care that PCPs can influence either through direct care or through referral to specialists or other ancillary practitioners. Identified priority measures are consistent with accepted clinical guidelines and are clinically relevant to CenCal Health’s membership.
All measures included in the program encourage increased utilization of treatment, screening and preventive health services which will improve the health status of CenCal Health members. Measures are evaluated annually and as priorities regarding these criteria change, CenCal Health may update measures. Generally, measures remain in the program for at least 2 years and no less than 1 year.
Measures Divided into Two Categories
- Priority Measures – Identified priority aspects of care included in incentive payment calculations
- Informational Measures – Identified aspects of care not included in incentive payment calculations
New QCIP Measures
CenCal Health added two new measures (listed below) to QCIP to support improved pediatric health outcomes. Services rendered and reported will be used to calculate QCIP incentive payments when these information only measures transition to priority (incentivized) measures in July 2025.
New QCIP measures are preceded by a performance or “lookback” period to assess adherence to guidelines for preventive health in each area of care. This evaluation is conducted before the payment date.
July 2025 Payment
- “Developmental Screening in the First Three Years of Life” assesses the percentage of children screened for risk of developmental, behavioral, and social delays using a standardized screening tool in the 12 months preceding or on their 1st, 2nd, or 3rd birthday.
- “Topical Fluoride for Children” assesses the percentage of children 1-4 years of age who received at least two fluoride varnish applications.
April 2026 Payment
- Osteoporosis Management in Women who had a Fracture
- Statin Therapy for Patients with Cardiovascular Disease – Received Statin Therapy
- Statin Therapy for Patients with Cardiovascular Disease – Statin Adherence 80%
- Kidney Health Evaluation for Patients with Diabetes
- Medication Adherence for Diabetes Medications
- Medication Adherence for Hypertension (RAS antagonists)
- Medication Adherence for Cholesterol (Statins)
- Annual Flu Vaccine
- Colorectal Cancer Screening
- Getting Needed Care
- Getting Appointments and Care Quickly
- Rating of Health Care Quality
For additional questions on the claims and billing process, please reach out to our claims department at cencalclaims@cencalhealth.org.
