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 aggregating a consolidated database of claims data submitted by GIC participating carriers, which are analyzed by GIC consultants, including Resolution Health, Inc. and Mercer/Vips. Subsequently, GIC participating plans utilize the findings provided by these GIC consultants to construct quality-of-care and efficiency profiles with which to develop "tiered" provider networks. For SFY2010, the claims data includes dates of service from 2005 through 2007.

Neighborhood Health Plan continues to work collaboratively with the GIC, its participating carriers and their consultants on the CPI Initiative.

Updated Methodology for SFY2010

Based on feedback from members, providers and other key stakeholders, the original methodology has been updated by GIC in order to make it easier to understand, include more quality data measures and produce greater consistency across the plans.

NHP's tiered network applies only to GIC enrollees. Tier assignments affect only copay amounts and have no impact on current contract terms and/or reimbursement rates.

CPII Resources

Important Documents

• Summary of State Fiscal Year 2010 CPII Methodology
• NHP SFY2010 GIC Plan Comparison
• Brief Overview of CPII Statistical Methodology
• RHI Overview of CPII Statistical Methodology
• GIC Posting Booklet for Round 5
• NHP CPII Physician Review Process Guidelines

Web Links

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