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Practitioner Excellence Program

Introducing the Enhanced Provider Pay-for-Performance Program: Highmark Health Options and Highmark Health Options Duals Practitioner Excellence (HHOPE) Program

Highmark Health Options and Highmark Health Options Duals (HMO SNP) recognizes the vital role primary care providers play in our members’ health. To reward excellence and encourage high-quality, accessible care, we've developed a new pay-for-performance program. We've worked closely with an advisory group of network PCPs to develop this program. We’re pleased to invite you to participate. This program reflects our commitment to improving health and wellness in our communities.

Overview
Open
  • Providers must opt-in to the program to be eligible for payments.
  • Providers must meet the minimum membership requirements noted in the section below.
  • Most measures within the HHOPE Program requires the entity to have a minimum of 10 members in the denominator to qualify to be scored.
  • Following the completion of the 2025 HHOPE Program, eligible providers will receive one payment. Payment will be made by July 31, 2026, to allow for final claims runout and data analysis.
  • Payments for most measures can be earned through benchmark achievement.
  • Profile measure is a quality metric that is being considered for ensuing program years but not immediately included in scoring. These measures are included for provider awareness and may be included as an incentivized measure in future HHOPE Program.
Eligibility Requirements
2025 Medicaid Program
  • Minimum panel size requirements are assigned membership of 250 at the entity level.
  • Primary Care Physicians: Family Practice, Internal Medicine, Pediatricians, Certified Registered Nurse Practitioners, Physician Assistants.

2025 D-SNP Medicare Program (No payments will be made for the D-SNP Medicare program; all measures are profiled.)

  • No minimum panel size requirement
    • Entity must have a minimum of 10 members in the denominator to be scored.
  • Primary Care Physician: Family Practice, Internal Medicine, Pediatricians, Geriatrician, Certified Registered Nurse Practitioner, Physician Assistants.
  • Profile measure is a quality metric that is being considered for ensuing program years but not immediately included in scoring. These measures are included for provider awareness and may be included as an incentivized measure in future HHOPE Program.
Program Guide

Download 2025 Highmark Health Options and Highmark Health Options Duals Practitioner Excellence Program Guide (PDF)

Training

Take the Training

Webinars

Join our webinar to learn more about the HHOPE Program, including detailed information about the quality measures, incentive structure, participation requirements, and how to optimize your practice for success.

 Date

 Time

 Webinar Link

 Wednesday, June 11

 9 a.m.

 Join the Teams Meeting

 Thursday, June 26

 11 a.m.

 Join the Teams Meeting

 Thursday, July 10

 10 a.m.

 Join the Teams Meeting

 Monday, July 28

 2 p.m.

 Join the Teams Meeting

 Tuesday, August 19

 10 a.m.

 Join the Teams Meeting

 Thursday, September 25

 10 a.m.

 Join the Teams Meeting
If you have any questions about the HHOPE Program, contact your Highmark Health Options Clinical Transformation Consultant or email at DePET@highmark.com.