Learn how the Bridge Program applies to NYCE PPO, Large Group, and ASO plan members in 2026.
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Quality Improvement
QUALITY IMPROVEMENT MATERIALS
Quality
Quality Measure Resource Guide
Quality Incentive Program
Maternity Quality Incentive Program
See What We Are Telling Our Members About Quality
Member Rewards Program
Social Determinants of Health (SDOH)
The Patient Experience- CAHPS/HOS Guide
Telehealth
Provider Manual
Provider Resources To Support Quality Care
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Quality
Our Quality Improvement programs are designed, implemented, and evaluated to support clinical excellence and promote the safety and well-being of our members.
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EmblemHealth demonstrates a strong commitment to quality improvement through a range of quality incentive programs that are structured to support providers at varying stages of participation. These programs are designed to simplify requirements and encourage engagement. In addition, our risk adjustment program offers incentives to primary care providers for accurate coding and billing for eligible EmblemHealth members enrolled in the NY State of Health (NYSOH) insurance marketplace, Medicare HMO, and Medicaid plans. Program qualifications and specifications are outlined below.
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The Quality Measure Resource Guide gives providers a concise overview of national and state quality measures* across preventive, acute, and chronic care to support clinical decision‑making and quality performance for our shared members.
*Measures included in the guide are sourced from National Committee for Quality Assurance (NCQA) www.ncqa.org, Centers for Medicare & Medicaid Services (CMS) https://www.cms.gov, and New York State Department of Health (NYSDOH) www.health.ny.gov.
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Quality Incentive Program Booklet
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EmblemHealth is committed to supporting the health and well-being of our members. Our provider network plays a critical role in this mission, and we value your shared dedication to delivering high-quality care. Through participation in our quality incentive programs (QIPs), providers may earn incentive payments tied to measures that improve meaningful health outcomes. Please refer to the PDF for detailed program requirements and specifications.
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Maternity Quality Incentive Program (MQIP)
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EmblemHealth’s Maternity Quality Incentive Program (MQIP) rewards OB/GYN providers for improving the quality of care for members during pregnancy and the postpartum period. The program is designed to increase access to essential care services and support providers in delivering exceptional maternal health outcomes.
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The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey captures members’ experiences with the care they receive. Provider communication, access to care, and care delivery directly influence CAHPS results. We encourage providers to review the available resources for an overview of the survey, including key questions and best practices that support high-quality, patient-centered care.
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Telehealth supports provider performance on Quality Incentive Program (QIP) measures by enabling timely care delivery, improving gap closure, and supporting accurate documentation and data submission. It can be used to address key QIP measures such as annual wellness visits, preventive screenings (e.g., breast and colorectal cancer screening documentation), chronic condition management (e.g., diabetes A1C control, blood pressure control), and post‑discharge follow‑up. Telehealth also supports success across commercial, Medicaid, and Medicare QIP and value‑based programs.
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Medical Policies
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Clinical Practice Guidelines
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Care-Case Management Library
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The Importance of the Second Blood Pressure Reading
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Transitions of Care Guide
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Guide to Advanced Illness and Frailty Exclusions
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Statin Therapy for Patients With Cardiovascular Disease and Diabetes
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Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
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Follow-up After Emergency Visit (FMC)
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2026 Supplemental Data Review
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2026 PowerBi Navigation
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2026 Supplemental Data Template
Social Determinants of Health (SDOH)
Social Determinants of Health (SDOH) are nonmedical factors that significantly influence patient outcomes and performance on quality measures. They include environmental, geographic, occupational, educational, and nutritional challenges.
Identifying and addressing SDOH can support gap closure, improve care delivery, and positively impact performance on preventive, chronic, and utilization‑based quality measures. Providers are encouraged to review the Guide to SDOH for Providers for practical strategies to incorporate SDOH into clinical workflows and documentation.