California Pay for Performance (P4P)

The California P4P program is the largest non-governmental physician incentive program in the United States. Founded in 2001, it is managed by the Integrated Healthcare Association (IHA) on behalf of eight commercial HMO health plans representing 9 million insured persons. IHA is responsible for collecting data, deploying a common measure set, and reporting results for approximately 35,000 physicians in 200 physician organizations. This program represents the longest running U.S. example of data aggregation and standardized results reporting across diverse regions and multiple health plans. California consumers benefit from the availability of standardized performance results from a common measure set, which are available to the public through the State of California, Office of the Patient Advocate.

NCQA is contracted by IHA to develop and maintain the clinical measures and audit methodologies and evaluate and audit the Meaningful Use of Health IT Domain Survey Tool responses.

Measurement Year (MY) 2013 Pay for Performance (P4P) Manual and Value Set Directories (VSDs)

The Measurement Year (MY) 2013 P4P manual and Value Set Directories (VSDs) are a required resource for California stakeholders participating in the Integrated Healthcare Association’s (IHA) California Pay for Performance (P4P) program. The MY 2013 P4P Manual features the technical specifications for all P4P measures as well as P4Ps general guidelines for data collection and reporting. The MY 2013 P4P VSDs provide an easy way to incorporate CPT©, ICD-9-CM, POS, MS-DRG, HCPCS, LOINC, TOB and UB codes into your organization’s data collection program—saving programming hours, eliminating the manual search for code and reducing keying errors. The MY 2013 P4P VSD consist of an electronic locked Excel file that is searchable and sortable.

For MY 2013 P4P, the codes (CPT©, ICD-9-CM, POS, MS-DRG, HCPCS, LOINC, TOB, and UB), will not be incorporated in the MY 2013 P4P Manual, but will be listed individually in the MY 2013 P4P VSDs. The MY 2013 P4P VSD User Manual and the June 2012 NDC list for the Proportion of Days Covered measure are also included in this download.

Note: A free version of the MY 2013 P4P Manual is available on the IHA website; however, the VSDs are only available for purchase below.

MY 2013 P4P Manual and VSDs

P4P Resources

MY 2012 P4P FAQs 

MY 2012 P4P Audit Manual 

MY 2012 P4P Crosswalk to HEDIS 2012 NDC Tables 

HEDIS 2013 Final NDC Lists