BQPP rewards independent primary care practices for providing high-quality, low-cost, and patient-centered care for Blue Cross NC members.
We offer qualifying independent primary care practices the opportunity to participate in the BQPP. This allows your practice to improve the care you give Blue Cross NC members.
Practices that meet BQPP criteria can receive a double-digit fee increase on their Evaluation and Management (E&M) and Preventive E&M codes. You can see how your practice will score in our Specialty Criteria section below:
level 2 (900 points) and level 3 (1015 points).
Practices that enter the BQPP will receive:
- Quarterly Practice Cost Efficiency reports. These show performance in relation to peer practices comparison with ER utilization, advanced imaging and specialist’s visits etc.
- Access to online Best Practice Sharing Forums. Learn from other BQPP participants and share ideas and lesson sin health care transformation.
Should your primary care practice apply for BQPP?
BQPP accepts independent practices that are accountable for meeting a patient’s physical and mental health care needs. This includes preventive and wellness visits and acute and chronic care. Both large and small practices with a comprehensive care team are accepted.
What primary care practices can apply?
- Family Practice
- Internal Medicine
- General Practice
- Multi-Specialty (Family Medicine/Pediatrics only)
Eligibility and Requirements
Must be PCMH recognized by:
Expiration date is required on application
- Electronic Health Record (EHR) is required
- An individual website not associated under the patient portal or Clinically Integrated Network
- At least 30 attributed Blue Cross NC members
- Practice Score Card
- Practice Website
- Contracted on the Standard Fee Schedule
- All providers, NP, PA, and other practitioners must be credentialed through Blue Cross NC
- Provider Engagement is required
- Provider Quality Report – pulled monthly
- Patient Portal – free for all patients and linked on website
- ACA Risk Adjustment Webinars
- Contracting Requirements PDF MUST BE REVIEWED BY PRACTICE
All BQPP elements listed below must be outlined and explained on your website (except for ACA Education and Cost).
- Advanced Care Team
- Social Determinants of Health
- Provider Education: ACA Risk Adjustment Education
You can learn more about credentialing or email your questions, provider numbers (NPI), contract questions, and sample fee schedule inquiries to NMSpecialist@bcbsnc.com.
All recognitions are valued at 500 points. All locations must be PCMH recognized.
Patient-Centered Medical Home (PCMH)
Primary Care practices can apply for URAC PCMH.
URAC’s Achievement program promises health care reform by:
- Increasing access to services
- Supporting care coordination across the continuum
- Improving patient accountability through information and decision making
- Driving efficiency and effectiveness
URAC’s PCMH program provides a unique approach to health care and strong educational support and cost advantages.
Primary Care practices can apply for the Joint Commission PCMH Certification.
The JCAHO PCMH certification focuses on care coordination, access to care, and how effectively a practice and team work with the patient.
To find out more about JCAHO PCMH Certification please visit www.jointcommission.org .
The following practices can apply for NCQA PCMH Certification:
- Family medicine
- Internal medicine
- General practice
Both NP and PA providers can achieve PCMH recognition.
PCMH recognizes practices that function as medical homes.
If your practice has multiple locations, all sites must be PCMH recognized.
NCQA offers a 20% discount to practices that are sponsored when they apply to receive their NCQA Recognitions. BCBSNC is considered your sponsor. Please enter the NCQA code "CNCBCA" on your NCQA application to receive the discount. Visit www.ncqa.org for more information.
Visit www.communitycarenc.org for NCQA PCMH cheat sheets and tools to assist you through the process.
Review the Adult Points Allocation Summary (pdf) for an overview of the points allocation.
Review Pediatric Points Allocation Summary (pdf) for an overview of the points allocation.
Review the FM Multi-Specialty Peds Points Summary (pdf) for an overview of the points allocation.
Additional Mandatory Requirements for All Providers
Provider Quality Report (PQR) = No Points
Your PQR must be pulled monthly from Blue e (this will be audited). We ask that practices use these reports to close care gaps.
We use the PQR as our gold-standard and the first element in scoring your practice’s quality. Practices with a denominator of 20+ will be scored ONLY using the PQR.
These reports show your practice performance against nationally recognized measures.
12-Month Rolling View: allows you to see where your practice is and how you’ve performed over the last 12 months.
Prospective View: show care gaps based on HEDIS measures, gaps currently open, and how likely your practice is to closing those gaps.
BQPP Practice Quality Scorecard
Points are awarded based on national benchmark percentiles.
- The numerator and denominator in your practice scorecard comes from your practice’s EHR.
- The multispecialty scorecard can only be used by practices with Blue Cross NC patients of at least 50% pediatrics.
- You must fill in a value for both the numerator and denominator for all measures. Put a “0” if your EHR cannot pull a measure.
- The denominator must be at least 20 to score.
Complete the scorecard spreadsheet and submit it with your application. Incomplete scorecards will delay your application results. DO NOT ADD, DELETE, OR CHANGE COLUMNS ON EXCEL FILES.
ACA Risk Adjustment Education = 25 Points
We have partnered with Pulse8 to provide you and your practice with education webinars related to risk adjustment and factor coding (HCC coding).
All new practices and new providers new to renewing practices, including NPs and PAs, are required to view two ACA risk adjustment (Pulse8) recorded or live webinars on Blue e. You can also read two PDF documents/webinars on Blue e. You must complete these prior to applying.
Renewing practices can view ACA webinars for additional points. ALL providers must participate.
- Email provider engagement the date and time you would like to attend. Write “Registration” in the subject line.
- You’ll receive a WebEx invitation with login information.
- Join the webinar when it’s time and sign in as a guest using your name and email.
- Access the ACA Risk Adjustment portal through Blue e under the Health Management tab.
- The education section will guide you to the webinars. Click the orange arrow to access them.
- Click the title to the right of the video to access the webinar under Archived Webinars.
Additional BQPP Elements
Addressing Social Determinants of Health = 100 points
- Patient portal (no points)
- Mandatory requirement
- Must have link to portal on practice website
- Electronic patient satisfaction survey
- Read "Measuring Patient Satisfaction: How to Do It and Why to Bother"
- Patient surveys can be distributed to patients through online systems such as Survey Monkey, Text, Email, Patient Portal etc.
- Patient surveys CANNOT be distributed through any type of paper document even if it is scanned into the EMR for BQPP points.
All applicable items must be on the practice website. Please ensure detailed class information is available for all patients. This is a class or program, in person (not webinar), held at the practice location weekly, monthly or quarterly. It can be an educator from the practice or from outside.
- Chronic disease management classes
- Prenatal education classes, breast feeding, parenting classes
- Exercise related activities
- Track RX program (Family Medicine and Pediatric)
- Weight-management nutrition classes
- Dental Heath at well-child visits (Pediatrics and Family Medicine)
- Primary care providers give oral fluoride starting at age 6 months for children with fluoride-deficient water supply
- Primary care providers apply fluoride varnish to primary teeth when teeth are visible
Advanced Care Team = up to 100 points
An Advanced care team model is highly encouraged. All Advanced Care team members must be listed on your practice website and be engaged with Blue Cross NC members to receive points.
Advanced Care Team members are:
- Health Coach (RN, LPN, or MA)
- PharmD or Pharm Tech
- Social Worker (LCSW or LPC)
- Case Manager/Care Coordinator (MA, RN, LPN or CNA)
If your practice partners with a behavioral health provider to provide mental health/substance treatment, you can attests to this on the application.
Improving Access = up to 250 points
Practice After Hours:
After hours care must be listed on your practice website to receive points. Specific points for each below is listed on the score sheets under each specialty criteria section.
- Weekday (hours after 5:00 pm and/or before 8:00 am)
- Total four hours each weekday (lunch hour doesn’t count)
- Seven hours on weekday
- Weekend Hours
- 2 hours on Saturday
- 2 hours on Sunday
- 4+ hours on Saturday
- 4+ hours on Sunday
- Co-management agreement with Urgent Care (practice with three providers or less only)
Telehealth following Blue Cross NC policy
Real Time Communication After Hours:
- Direct Provider Access Afterhours Phone Access
- Patient has direct access to Provider via phone
- NOT a nurse triage line or hospital line
- Patient has direct access to Provider via phone
- Direct Patient to Provider Messaging through patient portal Afterhours
- Provider responds after-hours within reasonable timeframe outlined by practice and posted on website
- Patient to provider directly, not nurse triage or hospital
Improving Cost = up to 250 points
The Practice Cost Report from Blue Cross NC is a report of your practice’s total cost of care compared to other peer practices in your specialty.
View our Improving Cost FAQ for more information.
The report includes:
- Primary Care Office Visits
- Emergency Room Visits
- Inappropriate ER Visits
- Specialist Visits
- Urgent Care Visits
- Inpatient Hospital Admissions
- Imaging (MRI and CAT Scans)
The stretch goal cost index is 0.93 or below. Practices above 1.17 will be placed on a cost-improvement plan for one year. Points are determined by your practice data divided by peer data.
Points are awarded as follows:
- 0.93 or below = 250 points
- 0.94 – 1.01 = 200 points
- 1.02 – 1.09 = 150 points
- 1.10 – 1.17 = 100 points
- 1.18 – 1.30 = 50 points
Application and Renewal
- Practices can apply twice a year: March 1 – April 30 or August 1 – September 30
- Practices must renew annually in order to keep BQPP reimbursement
- It can take up to 60 days to score your application
- Practices that do not follow instructions may have a delay in application results
Before You Begin the Application
Every practice must have at least 30 Blue Cross NC members. You need the following to complete your application:
- The practice group NPI number
- NPI numbers for all providers and mid-level practitioners
- Address and phone numbers for all practice locations
- Knowledge of any practice co-management agreements that are in place
- Practice Website must be updated with all BQPP elements
The application works best when using the latest Google Chrome browser.
Removal From Program
Reasons for Immediate Removal Include but are not Limited to:
- Falsification of application and/or attestations approved on application, such as after hours and patient portal, or provider education.
- Failure to maintain mandatory BQPP elements since practice's effective date with BQPP (not a part of annual renewal)
- Joining a Health System: this program is to solely benefit and equip practices that are independent and to provide them with tools and resources for advancement.
- Inadequate annual renewal – practices that can’t maintain program elements can be removed during application renewal
- Failure to review the PQR monthly via Blue e
- PCMH recognition Expiration without proof of renewal
- Blue Cross NC matters outside of the program: credentialing, contractual obligations, provider agreement issues, SIU, etc.
Case Management and Healthy Outcomes Program
Blue Cross NC offers Case Management of all patients. Do you need help supporting patients with chronic conditions? Refer them to our Case Management team.
The BQPP team will distribute quarterly “Best Practice Sharing Forums” online. This providers you the opportunity to share things you’ve learned and tools your practice uses for health care transformation with other BQPP practices.
- Best Practice sharing forum- named PQR and BQPP 2017
- Opioid Crisis Webinar
- November Best Practice Sharing Forum - MACRA video from BCBSNC and Ann Lefebvre
- Diabetes Focused presentation forum- June 20, 2017
- Diabetes/Pharmacy Case Study
- NCQA PCMH Pediatric 2017 Standards-Dr. Suzanne Berman
The opioid crisis in the United States directly affects your practice and BQPP providers. Dr. Anuradha Rao-Patel, Associate Medical Director at Blue Cross NC, has written a letter to guide all providers. The CDC guidelines are also beneficial to all providers in your practice. Please pass these resources to your providers.
Continuing Medical Education Courses:
These courses are optional for your practice and providers: