Improving Quality

Practice Improvement Program (PIP)

COVID-19 continues to have significant impacts in the health care delivery system. To ease reporting burden and allow financial support for the network, SFHP will be implementing the following for FY 2021-22:

  1. Decrease measure set from 28 total measures to 15 total measures.
  2. Allow for the optional allocation of capitation withhold to Health Equity Quality Improvement Projects (QIPs); funds to traditional PIP payments, 50% to Quality Improvement Projects.

The Practice Improvement Program (PIP) is San Francisco Health Plan’s pay-for-performance incentive program for Medi-Cal clinics and medical groups to achieve improvements in system and health outcomes.

Primary Objectives

Aligned with the Quadruple Aim:

  • Improving patient experience
  • Improving population health
  • Reducing the per capita cost of health care
  • Improving staff satisfaction

Provide Financial Incentives to Reward Improvement in the Provider Network

Program Eligibility Requirements
  • Clinics or medical groups that directly contract with SFHP (see below for current participants)
  • Assigned primary care medical home for 300+ SFHP members and/or HSF participants
Guiding Principles
  • Comprehensive measurement across multiple domains
  • Collaborative measure and program development
  • Standardized measurement across all provider groups
  • Financial incentives to motivate improvement
  • Technical assistance that supports ongoing improvements

Measure Domains

Clinical Quality
  • Measures generally come from external sources, prioritizing HEDIS and NCQA metrics
  • Factors taken into consideration are improvement potential, self- reporting feasibility, and how measure impacts SFHP (e.g. through auto-assignment)
Data Quality
  • Measures support both DHCS electronic data requirements and comprehensiveness of coding
Patient Experience
  • Measures based on lowest performing CAHPS composite (currently Access)
Systems Improvement
  • Measures support collaboration between various systems within which patients access care
Governance
  • Funding is determined by Executive Team and Governing Board every September.
  • PIP Advisory Committee provides input on measurement sets and advises on feasibility and alignment with other institutions.
  • SFHP Governing Board and SFHP Quality Improvement Committee receive high-level updates at least yearly.
2021-22 Current Participants:
  • Brown & Toland Physicians
  • Chinese Community Health Care Association
  • HealthRIGHT360
  • Hill Physicians Medical Group
  • Jade Health Care Medical Group
  • Marin City Health & Wellness Center
  • Mission Neighborhood Health Center
  • Native American Health Center
  • North East Medical Services
  • San Francisco Community Health Center
  • SFHN Primary Care
  • South of Market Health Center
  • St. Anthony Medical Clinic
  • UCSF Clinical Practice Group
  • UCSF Health
PIP 2021-22 Program Guide