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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) recognize 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.

2026 Program Overview
Open
  • Providers must opt-in to the program (either/both the Highmark Health Options Practitioner Excellence (HHOPE) 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.
  • Most measures within the HHOPE Program 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 measurement year. 
  • Following the completion of the 2026 HHOPE Program, eligible providers will receive one payment. Payment will be made by July 31, 2027, to allow for final claims runout and data analysis.
  • Payments can be earned through benchmark achievement, percentage point improvement over the prior year’s performance, or widget payments (specific criteria vary by measure).
Who Is Eligible for the 2026 Program?
2026 Medicaid Program
  • Minimum panel size requirements are a combined assigned membership of 100 for both Medicaid and DSNP lines of business at the entity level.
  • Primary Care Physicians: Family Practice, Internal Medicine, Pediatricians, Certified Registered Nurse Practitioners, Physician Assistants.
  • Obstetricians (requires 20 deliveries in the measurement year at the entity level)

2026 D-SNP Medicare Program 

  • Minimum panel size requirements are a combined assigned membership of 100 for both Medicaid and DSNP lines of business at the entity level.
  • Primary Care Physician: Family Practice, Internal Medicine, Pediatricians, Geriatrician, Certified Registered Nurse Practitioner, Physician Assistants.
If you have any questions about the Practitioner Excellence pay-for-performance program, please contact your Highmark Health Options Clinical Transformation Consultant or email us at DePET@highmark.com.

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