IHA releases a P4P Manual for each measurement year. The manual includes technical measure specifications along with data collection and reporting guidelines. A final measure set, audit manual and data submission file layouts are also released for each measurement year.
The organizations and individuals that have been licensed by NCQA to conduct HEDIS Compliance Audits, including audits for Pay for Performance, can be found at the link below.
IHA conducts a call for public comment prior to finalizing measures and specifications. The call for public comments is applicable to the following measurement year as well as modifications to the current measurement year. The public comment period is typically in September and October and the final P4P Manuals are released in mid-November.
In spite of a thorough validation and quality assurance process, it is possible for discrepancies to be found in the results in the P4P Preliminary Reports. Therefore, there is a formal appeals process for both physician organizations (POs) and health plans to appeal for changes. The appeals process occurs after the release of PO preliminary reports, which usually occurs in June of the reporting year.
“To drive major improvements, performance-based payments must exceed 10% of total provider income. Incentives of this magnitude can only be mobilized if they originate in payer savings.”
