Reward Plan Components
Quality
AHP is committed to continuously enhancing patient care, and our quality measures reflect this dedication. We have finalized our quality metrics for 2025 after successful negotiations with payers. These measures, which address the health of both adult and pediatric populations, can be found on our Quality Page. Practices will receive an outreach in the summer of 2025 that will include information about our transition to Health Catalyst, our new population health management platform, as well as a comprehensive review of the PCP Reward Plan components. AHP has developed several resources to assist providers in meeting our cost and quality goals, including:
- Provider Engagement Report: A dynamic, electronically delivered tool that provides providers with a comprehensive view of their Reward Plan performance.
- Pharmacy Pearls: Brief, informative newsletters covering various pharmacy topics, helping providers navigate shortages, medication switches, and best practices related to specific disease states.
| 2025 Quality Measures | Measure Description |
|---|---|
| Comprehensive Diabetes Care: HbA1c < 8.0 | The percentage of patients 18–75 years of age with diabetes (type 1 and type 2) whose most recent HbA1c in the measurement year was <8.0%. |
| Comprehensive Diabetes Care: Eye Exam | The percentage of patients 18–75 years of age with diabetes (type 1 and type 2) who had a retinal exam or dilated eye exam by an eye care professional in the measurement year, a negative retinal or dilated eye exam by an eye care professional in the measurement year or year prior, or bilateral eye enucleation. |
| Controlling High Blood Pressure | The percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose BP was adequately controlled to <140/90 during the measurement year. |
| Breast Cancer Screening | The percentage of women 50–74 years of age who had a mammogram to screen for breast cancer. |
| Colorectal Cancer Screening | The percentage of adults 50–75 years of age who had appropriate screening for colorectal cancer. |
| Childhood Immunization Status Combo 3 | Percentage of children 2 years of age who had 4 DTaP, 3 IPV, 3 HIB, 3 Hep B, 1 MMR, 1 VZV, and 4 pneumococcal conjugate vaccines by their 2nd birthday |
| Immunizations for Adolescents Combo 2 | Percentage of adolescents 13 years of age who had 1 meningococcal vaccine, 2-3 HPV, and 1 Tdap by their 13th birthday. |
| Well Care Visits in the First 30 Months of Life |
The percentage of members who had the following number of well-child visits with a PCP during the last 15 months: – Well-Child Visits in the First 15 Months: Children who turned 15 months old during the measurement year and had 6 or more well-child visits on or before the 15-month birthday. – Well Child Visits for Age 15 Months -30 Months: Children who turned 30 months old during the measurement year and had 2 or more well-child visits between the child’s 15-month birthday plus 1 day and the 30-month birthday. (2 separate numerators – each numerator reported and scored individually with measure points equally divided between the 2 numerators) |
| Fall Risk Management | Percentage of patients 65 years of age or older who had a fall or had problems with balance or walking in the past 12 months, who were seen by a practitioner in the past 12 months and who received a recommendation for how to prevent falls or treat problems with balance or walking from their current practitioner. |
| DM Kidney Health | The percentage of members 18-85 years of age with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by and estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR) during the measurement year. |
Pharmacy Savings Program
The Pharmacy Savings Program focuses on switching patients to less costly alternatives. Aligning with an AHP priority, using cost-saving methods in prescribing medications is crucial for several reasons:
- Substantial Cost Reduction: reduce expenses for patients and the healthcare system, while providing the same clinical benefit.
- Insurance Compatibility: Prescribing these cost-effective alternatives ensures patients can receive the least expensive product covered by their insurance, enhancing accessibility and adherence to treatment.
- Avoiding Unnecessary Costs: Providers might unknowingly prescribe more expensive medications. Adjusting electronic medical records (EMR) to favor cost-effective options and canceling unnecessary prescriptions can prevent inadvertent high-cost prescribing.
- Maintaining Clinical Efficacy: All recommended cost-saving alternatives are clinically equivalent to their more expensive counterparts, ensuring that patients receive effective treatment without added financial burden.
- Streamlining Pharmacy Processes: Writing prescriptions correctly (e.g., specifying “dispense as generic” and ensuring DAW0 for metformin XR) simplifies the process at the pharmacy, reducing errors and ensuring the correct, cost-effective medication is dispensed.
Prioritizing these cost-saving strategies can help manage healthcare costs effectively while maintaining high-quality patient care.
Citizenship
The citizenship component offers two pathways for providers to complete the requirements: at the practice level or the individual level. Practices earn citizenship by completing two or more specified components, such as attending meetings, participating in projects, or implementing certain initiatives. Individual providers can also achieve citizenship by fulfilling criteria like attending information sessions, subscribing to emails, or meeting patient engagement targets. The two tables below provide detailed information on the citizenship components.
| 2025 Citizenship Criteria | |||||||
|---|---|---|---|---|---|---|---|
| Practice Component | Subcomponent | Specialty | Criteria | ||||
| Practice manager meeting attendance | All | Practice Manager attends two or more PM meetings in 2025 | |||||
| Participates in administrative project, IPC pilot or optimization pilot | Collaborative Care Pilot | IM, FM | Engaged in contracting with Concert Health or Pediatric Collaborative Care Grant | ||||
| Participates in administrative project, IPC pilot or optimization pilot | Trauma-informed Primary Care Project | All | Practice meets with the Trauma-Informed Care team in 2025 | ||||
| Participates in administrative project, IPC pilot or optimization pilot | Comprehensive Developmental Screening Project | Peds, FM | Engaged in pilot | ||||
| Participates in administrative project, IPC pilot or optimization pilot | Depression Screening & Follow-Up Project | All | Practice meets with the project team on Depression Screening or Follow Up in 2025 | ||||
| Participates in administrative project, IPC pilot or optimization pilot | SMART Education | Peds, FM | Practice meets with the Asthma Team in 2023, 2024, or 2025 | ||||
| Participates in administrative project, IPC pilot or optimization pilot | Geriatric Support Care Pilot | Geriatrics, IM | Engaged in pilot | ||||
| Participates in administrative project, IPC pilot or optimization pilot | Other AHP Identified Initiative | All | Engaged in pilot | ||||
| Health Catalyst Implementation | All | Practices Implemented in 2024: Practice continues to work with AHP team to implement Health Catalyst (i.e. data validation) or attends educational session in 2025 Practices Implemented in 2025: Practice works with AHP Team on Health Catalyst Implementation in 2025 (i.e., timely response, data validation, etc.) |
|||||
| Provider Component | Specialty | Criteria |
|---|---|---|
| Attends CGR or other AHP Information sessions | All | Provider has attended two or more AHP information sessions (i.e. Clinical Grand Rounds) |
| Subscribes to email communications | All | At the time data is pulled, provider is subscribed to receive AHP communications. |
| Accepting new patients | All | At the time data is pulled, provider’s status is set to Yes for accepting new patients |
| Serves on AHP Board or board committee | All | At the time data is pulled, provider is a member of the AHP board, finance or membership. |
| Vatica | All | Provider has contracted with Vatica and achieved 20% penetration in Excellus year end reporting averaged across all LOBs (Medicare, Medicaid, Commercial) |
2024 Reward Plan
| 2024 Quality Measures | Measure Description |
|---|---|
| Comprehensive Diabetes Care: HbA1c < 8.0 | The percentage of patients 18–75 years of age with diabetes (type 1 and type 2) whose most recent HbA1c in the measurement year was <8.0%. |
| Comprehensive Diabetes Care: Eye Exam | The percentage of patients 18–75 years of age with diabetes (type 1 and type 2) who had a retinal exam or dilated eye exam by an eye care professional in the measurement year, a negative retinal or dilated eye exam by an eye care professional in the measurement year or year prior, or bilateral eye enucleation. |
| Controlling High Blood Pressure | The percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose BP was adequately controlled to <140/90 during the measurement year. |
| Breast Cancer Screening | The percentage of women 50–74 years of age who had a mammogram to screen for breast cancer. |
| Colorectal Cancer Screening | The percentage of adults 50–75 years of age who had appropriate screening for colorectal cancer. |
| Childhood Immunization Status Combo 3 | Percentage of children 2 years of age who had 4 DTaP, 3 IPV, 3 HIB, 3 Hep B, 1 MMR, 1 VZV, and 4 pneumococcal conjugate vaccines by their 2nd birthday |
| Immunizations for Adolescents Combo 2 | Percentage of adolescents 13 years of age who had 1 meningococcal vaccine, 2-3 HPV, and 1 Tdap by their 13th birthday. |
| Well Care Visits in the First 30 Months of Life |
The percentage of members who had the following number of well-child visits with a PCP during the last 15 months: Well-Child Visits in the First 15 Months: Children who turned 15 months old during the measurement year and had 6 or more well-child visits on or before the 15-month birthday. Well Child Visits for Age 15 Months -30 Months: Children who turned 30 months old during the measurement year and had 2 or more well-child visits between the child’s 15-month birthday plus 1 day and the 30-month birthday. |
| Fall Risk Management | Percentage of patients 65 years of age or older who had a fall or had problems with balance or walking in the past 12 months, who were seen by a practitioner in the past 12 months and who received a recommendation for how to prevent falls or treat problems with balance or walking from their current practitioner. |
| DM Kidney Health | The percentage of members 18-85 years of age with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by and estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR) during the measurement year. |
2024 Citizenship Criteria
| Practice Component | Subcomponent | Specialty | Criteria |
|---|---|---|---|
| Practice manager meeting attendance | All | Practice Manager attends two or more PM meetings in 2024 | |
| Participates in administrative project, IPC pilot or optimization pilot | Collaborative Care Pilot | IM, FM | Engaged in contracting with Concert Health or Pediatric Collaborative Care Grant |
| Participates in administrative project, IPC pilot or optimization pilot | Trauma-informed Primary Care Project | All | Practice meets with the Trauma-Informed Care team in 2024 |
| Participates in administrative project, IPC pilot or optimization pilot | Comprehensive Developmental Screening Project | Peds, FM | Engaged in pilot |
| Participates in administrative project, IPC pilot or optimization pilot | Depression Screening & Follow-Up Project | All | Practice meets with the project team on Depression Screening or Follow Up in 2024 |
| Participates in administrative project, IPC pilot or optimization pilot | SMART Education | Peds, FM | Practice meets with the Asthma Team (Paul, Bob A., Sarah L., LJ Shipley in 2023 or 2024 |
| Participates in administrative project, IPC pilot or optimization pilot | Geriatric Support Care Pilot | Geriatrics, IM | Engaged in pilot |
| Participates in administrative project, IPC pilot or optimization pilot | Other AHP Identified Initiative | All | Engaged in pilot |
| Health Catalyst Implementation | All | Practices Implemented in 2024: Practice continues to work with AHP team to implement Health Catalyst (i.e. data validation) in 2024 Practices Implemented in 2025: Practice attends educational session on Health Catalyst Implementation in 2024 |
|
| Provider Component | Specialty | Criteria |
|---|---|---|
| Attends CGR or other AHP Information sessions | All | Provider has attended two or more AHP information sessions (i.e. Clinical Grand Rounds) |
| Subscribes to email communications | All | At the time data is pulled, provider is subscribed to receive AHP communications. |
| Accepting new patients | All | At the time data is pulled, provider’s status is set to Yes for accepting new patients |
| Serves on AHP Board or board committee | All | At the time data is pulled, provider is a member of the AHP board, finance or membership. |
| Vatica | All | Provider has contracted with Vatica and achieved 20% penetration in Excellus year end reporting averaged across all LOBs (Medicare, Medicaid, Commercial) |


