Clinical Performance Improvement Initiative (CPII)

In an effort to promote quality improvement and cost efficiency in the delivery of health care, in 2003 the Massachusetts Group Insurance Commission (GIC) established the Clinical Performance Improvement Initiative (CPII).

CPII involves aggregation of a consolidated multi-plan claims database of over 150 million claim lines submitted by GIC participating carriers to be analyzed by the GIC consultants Resolution Health Inc. and Mercer/Vips. Subsequently, GIC participating plans use the findings provided by these GIC consultants to construct quality of care and efficiency profiles and in developing "tiered" networks.

NHP continues to work collaboratively with the GIC, its participating carriers and their consultants on the CPI Initiative. The original methodology has been updated by GIC as a result of feedback from members, providers and other key stakeholders to make it easier to understand, include more quality data measures, and produce greater consistency across the plans.

NHP tiers providers at the group level for primary care providers and individually for select physician specialties. Tier assignments affect only copayment amounts and have no impact on a provider's current contract terms and/or reimbursement rates.

Tiered network applies only to GIC enrollees. A tier designation is not an endorsement or recommendation by NHP and does not suggest high quality or substandard care for an individual patient by any given practice or provider. In addition to quality designations, other factors such as a provider's medical training, hospital affiliation, malpractice history, appointment access and interpersonal skills should be considered by a member when selecting a provider.

CPII Resources

Important Documents

• State Fiscal Year 2011 CPII Methodology
• Brief Overview of CPII Statistical Methodology
• RHI Summary of Statistical Approach in GIC CPII Evaluation
• NHP CPII Physician Review Process Guidelines

Web Links

• NHP Online Provider Directory
• Information about tiering from the Group Insurance Commission (GIC) CPII Resource