Practitioner Excellence Program

• Providers must opt-in to the program (either/both the Highmark Wholecare Practitioner Excellence (HWPE) Program and the Maternity Quality Program) to be eligible for payments.
• Providers must meet the minimum membership requirements noted in the Who Is Eligible for the Program section below.
• Each measure within the HWPE requires the entity to have a minimum of 10 members in the denominator to qualify to be scored. The measures within the Maternity Quality Program have a minimum requirement of 20 deliveries within the measure year.
• Following the completion of the 2023 HWPE Program, eligible providers will receive one payment. Payment will be made by June 30, 2024, to allow for final claims runout and data analysis.
• Payments can be earned through benchmarks and/or a percentage point improvement over the prior year’s performance. Additional percentage point improvement dollars can be earned through Health Equity Measures, for year-over-year improvement for black members within specific measures.

2023 Medicaid Program:

• Minimum panel size requirements are a combined membership of 500 for both Medicare and Medicaid lines of business at the entity level.
• Primary Care Physician: Family Practice, Internal Medicine, Pediatricians, Certified Registered Nurse Practitioner, Physician Assistants, Obstetrician.
• Dentists (no minimum panel size required).

2023 Medicare Program:

• Minimum panel size requirements are as follows
  – 100 Medicare members at the entity level OR 500 combined Medicare/Medicaid members at the entity level (membership is through assignment).
  – Federally Qualified Health Centers (FQHCs) are automatically eligible.

• Primary Care Physician: Family Practice, Internal Medicine, Pediatricians, Certified Registered Nurse Practitioner, Physician Assistants.