Overview of the Clinical Performance Improvement Initiative pptx format of CPI_description_FY18.pptx

The Clinical Performance Improvement (CPI) Initiative combines the plans' commercial claims data to assess each Massachusetts physician's adherence to quality standards, as well as the cost-efficiency of his or her practice relative to other physicians in the same specialty treating patients with similar clinical conditions
Your tier assignment was based on your overall quality score of adjusted quality score and your efficiency score.  Tier 1 physicians received the highest quality scores and provided the most cost-efficient care (using standardized, or proxy, prices, not providers' contracted rates).  Patients who see these doctors pay the lowest office visit copayments. (Note: certain health plans may not tier you because you are not in the plan's network.)

– Health insurers tier individual physicians, placing approximately 20% in Tier 1, 65% in Tier 2, 15% in Tier 3
– Provider tiers are published in provider directories –not a publicly distributed “Report Card

NEW FOR FY 2018: 

  • The GIC has authorized HPHC and Tufts Health Plan to use their own tiered products based on group cost and quality performance. For these plans, tier placement for GIC members will be determined by the physician’s performance within their respective HPHC physician group and Tufts Health Plan IPA group. Tier placement will apply to both Specialists and PCPs.
    • For additional information please refer to the following web pages:
      • www.harvardpilgrim.org/providers > Products > The Harvard Pilgrim GIC Plans
      • https://tuftshealthplan.com/provider/news/2017/-gic-tiering-info
  • Each physician, covered by the CPI Initiative, will receive the same tier assignment from the following GIC plans: Fallon, HNE, NHP, and UniCare.











CPII Tier Assignment information is only applicable to Fallon, HNE, NHP and UniCare plans 

PCP copay information is only applicable to POS plans within HPHC physician groups and Tufts Health Plan IPA groups

This information provided by the Group Insurance Commission.