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’re pleased to invite you to participate. This program reflects our commitment to improving health and wellness in our communities.

Overview

Providers must opt-in to the program to be eligible for payments.
Providers must meet the minimum membership requirements noted in the section below.
Each measure within the HHOPE Program requires the entity to have a minimum of 3 members in the denominator to qualify to be scored.
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 run out and data analysis.
Payments can be earned through gap closure for each program measure.

Eligibility Requirements

2026 Medicaid Program:

Minimum panel size requirements are a combined assigned membership of 5 for both Medicaid and D-SNP at the entity level.
Primary Care Physicians: Family Practice, Internal Medicine, Pediatricians, Certified Registered Nurse Practitioners, Physician Assistants, Obstetricians.
Dentists (no minimum panel size required).

2026 D-SNP Medicare Program:

Minimum panel size requirements are a combined assigned membership of 5 for both Medicaid and D-SNP at the entity level.
Primary Care Physicians: Family Practice, Internal Medicine, Pediatricians, Certified Registered Nurse Practitioners, Physician Assistants, Obstetricians.

Program Guide

Training

If you have any questions about the HHOPE Program, contact your Highmark Health Options Clinical Transformation Consultant.

Be Informed

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