EQIP is an episode-based payment program for non-hospital physicians designed to: 

• Help the State meet the financial targets of Total Cost of Care (TCOC) Model
• Include more physicians in a value-based payment framework (that is, to have responsibility and share in rewards for reducing Medicare TCOC spending)
• Encourage multi-payer alignment in a value-based payment framework
• Include more episodes than in Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMI) models
• Broaden access to Medicare’s Advanced APM (AAPM) MACRA opportunity

EQIP will provide the State with input on:

• Episodes to include (prioritization), and
• Episode design, recognizing there are annual opportunities for updates and participation.

• Episode of Care Definitions
  The Episodes of Care Definition Summary Descriptions are designed to facilitate understanding of the scope and boundaries of a specific episode.

• Prometheus Grouper
  • Episodes by Clinical Chapters
    Note: The vast majority of the episodes have not yet been fully defined, reviewed and updated. We welcome participation in Clinical Working Groups to continue the work of reviewing and fully defining each episode.
  • Next 100 List
    This is a list of episodes that the PACES team have nearly finalized but looking for clinical experts to validate. 
    
  • After extensive analysis and meetings with specialty stakeholders, the HSCRC will move forward with utilizing Patient-Centered Episodes of Care System (PACES) as the EQIP episode grouper, starting in PY4 (CY2025).  While many PACES episodes are undergoing final clinical review and updates, the system offers much more complete coverage than PROMETHEUS and paves the way for easier, more seamless program expansion in future years. Current EQIP episode categories are well-covered by finalized PACES categories and overall, a high degree of alignment has been found for episodes currently available under EQIP
    

Meeting Materials

EQIP Subgroup Meeting Slides

EQIP Subgroup Meeting Video Recordings

Quality Measures

EQIP quality measures will be evaluated via claims data.  Meaning the CPTs must show up in the claims data. 

The CMS guidelines for the measures can be found here:

• Advance Care Plan - MEDICARE PART B CLAIMS
• Documentation of Current Medications in the Medical Record - MIPS CLINICAL QUALITY MEASURES (CQMS)
  
• Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan - MIPS CLINICAL QUALITY MEASURES (CQMS)