2024 Provider Incentive Program – Quality Measures for FQHC & RHC
| Date: | March 01, 2024 |
| From: | Health Plan |
| To: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHC) |
| Type: | Informational |
| Subject: | 2024 Provider Incentive Program – Quality Measures for FQHC & RHC |
| Business: | Medi-Cal Managed Care |
Health Plan is pleased to announce the 2024 Provider Incentive Program. This program rewards our providers for promoting quality care for our members. Program guidelines and quality measures are described below.
The Quality Measures include Healthcare Effectiveness Data and Information Set (HEDIS) and the Managed Care Accountability Set (MCAS). MCAS are performance measures that the Department of Health Care Services (DHCS) selects for annual reporting for Medi-Cal managed care health plans.
2024 Participation Criteria
Federally Qualified Health Center (FQHC)
1. Maintain a minimum of 500 Health Plan members
2. Remain open to new members for the entire calendar year
Rural Health Center (RHC)
1. Maintain a minimum of 50 Health Plan members
2. Remain open to new members for the entire calendar year
Incentives
The total amount available for each measure is determined by the average number of assigned members during the calendar year and the level of achievement reached.
Performance is incentivized per the following structure:
Percentiles are based on NCQA HEDIS rates
| Performance Level | Incentive Amount |
|---|---|
| Quality Measure total rate result for assigned members is less than 25th percentile | No incentive payment for the measure |
| Quality Measure total rate result for all assigned members meets 25th percentile but less than 33rd percentile | 30% of the total budgeted amount for the measure |
| Quality Measure total rate result for all assigned members meets 33rd percentile but less than 50th percentile | 60% of the total budgeted amount for the measure |
| Quality Measure total rate result for all assigned members meets 50th percentile but less than 66th percentile | 100% of the total budgeted amount for the measure |
| Quality Measure total rate result for all assigned members meets or surpasses 66th percentile | Additional $10,000 for the measure (up to 10 measures total) |
Health Plan will incentivize provider performance on the following 18 target measures:
| # | Behavioral Health Domain Measures | ACRONYM |
|---|---|---|
| 1 | Follow-Up After ED Visit for Mental Illness – 30 days | FUM |
| 2 | Follow-Up After ED Visit for Substance Abuse – 30 days | FUA |
| # | Childrens Health Measures | ACRONYM |
| 3 | Child and Adolescent Well-Care Visits | WCV |
| 4 | Childhood Immunization Status: Combination 10 | CIS-10 |
| 5 | Developmental Screening in the First Three Years of Life | DEV |
| 6 | Immunizations for Adolescents: Combination 2 | IMA-2 |
| 7 | Lead Screening in Children | LSC |
| 8 | Well-Child Visits in the First 30 Months of Life – 0 to 15 Months – Six or More Well-Child Visits* | W30-6+ |
| 9 | Well-Child Visits in the First 30 Months of Life – 15 to 30 Months –Two or More Well-Child Visits* | W30-2+ |
| # | Chronic Disease Management Measures | ACRONYM |
| 10 | Asthma Medication Ratio | AMR |
| 11 | Controlling High Blood Pressure | CBP |
| 12 | Hemoglobin A1c Control for Patients With Diabetes – HbA1c Poor Control (> 9%) | HBD |
| # | Reproductive Health Domain Measures | ACRONYM |
| 13 | Chlamydia Screening in Women | CHL |
| 14 | Prenatal and Postpartum Care: Postpartum Care | PPC-Pst |
| 15 | Prenatal and Postpartum Care: Timeliness of Prenatal Care | PPC-Pre |
| # | Cancer Prevention Measures | ACRONYM |
| 16 | Breast Cancer Screening | BCS-E |
| 17 | Cervical Cancer Screening | CCS |
| 18 | Colorectal Cancer Screening | COL |
Bonus Incentives for Improved Performance
Additional incentives can be earned for up to 10 measures that improved at least 3 to 5 percentile points compared to calendar year 2023. Incentive amounts are determined by the average number of assigned members during the calendar year.
Improvement Targets
• Children and behavioral health measures: 3 percentile points or more
• All other measures: 5 percentile points or more
We look forward to a continued partnership.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website WWW.HPSJ-MVHP.ORG