The HPC works to monitor the performance of individual payers and providers against the Commonwealth’s health care cost growth benchmark, and may require payers and providers with excessive spending growth to implement a performance improvement plan.
The HPC and the Center for Health Information and Analysis (CHIA) share responsibility for monitoring health care spending in Massachusetts and measuring performance against the health care cost growth benchmark. In addition to evaluating performance for the Commonwealth as a whole, the agencies review individual payer and provider group spending performance through the Performance Improvement Plan (PIP) process. During this annual process, CHIA confidentially refers to the HPC payers and providers with high health status adjusted spending growth. The HPC then conducts a confidential, robust review of all referred organizations and directly engages with payers and providers to understand the drivers of health care spending, and to encourage both to drive towards greater efficiency. Based on its findings, the HPC may also require a PIP of an organization where it identifies significant concerns regarding that organization’s spending performance and finds that a PIP could result in meaningful, cost-saving reforms.
The PIPs process is one of the key enforcement mechanisms included in Chapter 224 of the Acts of 2012, the Commonwealth’s landmark cost-containment law, and began in 2016.
Performance Improvement Plan Process Overview
Statute, Regulations, and Guidance
- M.G.L. c. 6D, § 10
- 958 CMR 10.00: Performance Improvement Plans
- Policy 2017-01 Process for Performance Improvement Plans
PIPs Forms
- General Instructions (958 CMR 10.02)
- Performance Improvement Plan - Proposal Form (958 CMR 10.02)
- Performance Improvement Plan - Entity Contact Information (958 CMR 10.02)
- Performance Improvement Plan - Request for Waiver (958 CMR 10.02)
- Performance Improvement Plan - Affidavit (958 CMR 10.02)
- Performance Improvement Plan - Request for Extension (958 CMR 10.02)
Entities Currently Required to File a PIP
- None
Previously Implemented PIPs