As previously communicated in a
Partners in Health UpdateSM
article,
effective January 1, 2021, Independence will launch a new nephrology pay for value (NeP4V) program focused on chronic kidney disease (CKD) and end-stage renal disease (ESRD) members. The NeP4V program is the first incentive-based model offered to nephrology practices in the Independence network.
Program incentives
The NeP4V program will give nephrology practices an opportunity to earn incentives for continually improving the quality of medical care and service they provide Independence Commercial and Medicare Advantage members with advanced CKD (stages 4 and 5) and ESRD. Practices must meet certain prerequisites to be eligible for participation and payment in the NeP4V program.
Payment incentives will be based on the kidney care measures outlined below.
Kidney care measures
The kidney care measures are based on services provided during the reporting period (January through December of the measurement year, unless otherwise noted). Accurate encounter and claims submissions are important to document these services.
The kidney care measures for measurement year 2021 are:
- at-home dialysis therapy for ESRD members
- emergency room/department and inpatient utilization for CKD 4, CKD 5, and ESRD members
- optimal ESRD starts
- transplants per year when member remains dialysis free at 12 months post-transplant
NeP4V program prerequisites
A complete list of the program prerequisites is outlined in the NeP4V program manual.
One requirement is that nephrology practices must be enabled to use PEAR Analytics & Reporting (formerly IndexProTM), our practice reporting tool accessed through the Provider Engagement, Analytics & Reporting (PEAR) portal, to view all NeP4V program-related reports in addition to other valuable value-based data. Learn more on how to enroll for access to the PEAR portal
here.
Learn more
Review the NeP4V program manual, available on our
value-based program page, to learn more about the program. If you have questions, please email us at NeP4V@ibx.com.