January 11, 2026
We have important information to share about our Quality Care Plus (QCP) program, including an overview of updates for the 2026 QCP program.
2026 QCP Program Updates
Our QCP program rewards your practice’s performance for delivering quality services to our members. Each year, we assess the program to ensure that it positively affects our members and providers. We typically add and remove measures, as well as adjust the benchmarks and payment amounts based on historical performance, network performance, NCQA benchmarks, and CMS Stars benchmarks.
The changes outlined below will impact the 2026 measurement year (January 1 through December 31, 2026) and payments beginning in May 2027 (unless otherwise noted). Further clarification about how membership is calculated will be included in the QCP Manual.
Overall Program Changes
1. Medicaid Measure Benchmark Changes: In an effort to continue to align QCP Program benchmarks with national benchmarks, we will align the Medicaid QCP measure benchmarks with the most recently released (September 2025) NCQA Quality Compass Benchmarks. Medicaid measures will now have three tiers instead of four tiers. Tier 1, 2 and 3 benchmarks will align with the NCQA Quality Compass 66.67th, 75th and 90th percentiles, respectively. Benchmarks for measures that are not NCQA measures will continue to be set based on historical performance and network performance.
2. Medicare Measure Benchmark Changes: Medicare measure benchmarks will continue to align with the most recently available Stars benchmarks; however, the first tier will now equate to the 4 Star Medicare benchmark, the second tier will now equate to the 4.5 Star Medicare benchmark (the average of 4- and 5- Star benchmarks), and the third tier will now equate to the 5 Star Medicare benchmark.
3. New Bundle Measure Bonus Payments: We will add three new bundle measure payment bonus opportunities for providers, based on the DHS prescribed bundle measures for Managed Care Organizations (MCOs). These bundles include:
- Child and Adolescent Well-Care Visits (WCV) and Well-Child Visits in the First 15 Months Age Band (W15)
- Controlling High Blood Pressure (CBP) and Glycemic Status Assessment for Patients with Diabetes (GSD), and
- Lead Screening for Children (LSC) and Developmental Screening in the First Three Years of Life (DEV).
Providers will be eligible to earn an additional $1 PMPM for each of the three bundles if they reach Tier 2 (NCQA 75th percentile) for both measures in each bundle. The PMPM will be based on the number of members in each individual measure denominator, not the panel size of the TIN. This payment is in addition to any payment earned for each individual measure.
4. Health Disparity Bonus Payment (Medicaid): As part of our shared commitment with DHS to address health disparities, we will offer a bonus payment specific to the Hispanic/Latino population in addition to the bonus payment specific to the African American population. Medicaid sites will have the opportunity to earn a bonus payment on each eligible measure, in addition to their payment received for the measure for the entire population. Sites must hit Tier 2 or Tier 3 for only their African American and/or Hispanic/Latino members to earn the bonus for any of the following 3 disparity measures: (1) Well-Child Visits- First 15 Months of Life; (2) Glycemic Status Assessment for Patients with Diabetes HbA1c/GMI <=9; and/or (3) Controlling Blood Pressure.
2026 Quality Measure Changes
New Measures:
- Concurrent Use of Opioids and Benzodiazepines (COB):* This measure was adapted from the Concurrent Use of Opioids and Benzodiazepines developed and endorsed by the Pharmacy Quality Alliance (PQA) to monitor performance on the percentage of Medicare members 18 years and older with concurrent use of both opioids and benzodiazepines (30 or more cumulative days).
- Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH): This measure, also endorsed by the Pharmacy Quality Alliance (PQA), measures the percentage of Medicare members 65 years and older with concurrent use of unique anticholinergic medications.
*Provider resource guides for these measures can be found on the Quality page of our website: hpplans.com/qualityandpopulationhealth. Additional details will also be provided in the 2026 QCP Manual.
Retired Measures:
- Diabetes Eye Exam (Medicaid only; this measure will remain for Medicare)
- Member Satisfaction – Office Staff (Medicaid)
- Member Satisfaction – Provider (Medicaid)
- Annual Wellness Visit (Medicare)
- Health-Related Social Needs (HRSN) (Medicaid)
See below for the complete list of the Medicare, Medicaid, and CHIP measures included in the 2026 program.
For More Information
The updated 2026 QCP Manual is expected to be released at the end of the year and will include all appropriate information. The 2026 QCP manual will be available at hpplans.com/qualityandpopulationhealth.
Your Provider Relations Representative will be working closely with you to ensure that your office understands these changes and to answer any questions.
You can also contact our Provider Services Helpline at 1-888-991-9023, Monday to Friday, 9 a.m. to 4:30 p.m.
2026 QCP Program Measures
Here is the complete list of the Medicare, Medicaid and CHIP measures included in the 2026 program. The measurement period is January to December 2026 (to be reflected in payments beginning in May 2027).
Measure: Asthma Medication Ratio
Population: Pediatric/Adult
Medicaid, CHIP
Measure: Breast Cancer Screening
Population: Adult
Medicare, Medicaid
Measure: Care of Older Adults - Functional Assessment
Population: Adult
Medicare
Measure: Care of Older Adults – Medication Review
Population: Adult
Medicare
Measure: Child and Adolescent Well-Care Visits
Population: Pediatric/Adult
Medicaid, CHIP
Measure: Childhood Immunization Status
Population: Pediatric
Medicaid, CHIP
Measure: Colorectal Cancer Screening
Population: Adult
Medicare
Measure: Concurrent Use of Opioids and Benzodiazepines (COB) (NEW)
Population: Adult
Medicare
Measure: Controlling High Blood Pressure
Population: Adult
Medicare, Medicaid
Measure: Developmental Screening in the First Three Years of Life
Population: Pediatric
Medicaid
Measure: Diabetes: Eye Exam
Population: Adult
Medicare
Measure: Diabetes: HbA1c Control (<9%)
Population: Adult
Medicare
Measure: Glycemic Status Assessment for Patients with Diabetes
Population: Adult
Medicaid
Measure: Health-Related Social Needs (HRSN) previously Social Determinants of Health
Population: Pediatric/Adult
Medicaid
Measure: Kidney Health Evaluation for Patients with Diabetes
Population: Adult
Medicare
Measure: Lead Screening in Children
Population: Pediatric
Medicaid, CHIP
Measure: Medication Adherence for Cholesterol Medications
Population: Adult
Medicare
Measure: Medication Adherence for Diabetes Medications
Population: Adult
Medicare
Measure: Medication Adherence for Hypertension Medications
Population: Adult
Medicare
Measure: Medication Reconciliation Post-Discharge
Population: Adult
Medicare
Measure: Patient Engagement After Inpatient Discharge
Population: Adult
Medicare
Measure: Plan All-Cause Readmissions (PCR)
Population: Adult
Medicare, Medicaid
Measure: Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) (NEW)
Population: Adult
Medicare
Measure: Well-Child Visits for Age 15 Months – 30 Months
Population: Pediatric
Medicaid, CHIP
Measure: Well-Child Visits, First 15 Months of Life
Population: Pediatric
Medicaid, CHIP