For GIC customers and members only: A tiering of providers based on quality and efficiency.
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 the aggregation of a consolidated multi-plan claims database from all GIC participating carriers to construct quality of care and cost-efficiency profiles used in developing a tiered network of providers.
Final tiers of providers are based on the quality and efficiency scores provided after extensive analysis of the paid and denied claims submitted by the health plans and are applied by NHP without modification.
NHP's Tiered Network applies to Group Insurance Commission (GIC) enrollees only.