2024 Provider Incentive Program-Quality Measures for PCP/OB-GYN

Print Friendly, PDF & Email

Date: March 01, 2024
From: Health Plan
To: Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Primary Care Providers (PCPs), Obstetrician-Gynecologist (OB-GYN
Type: Informational
Subject: 2024 Provider Incentive Program-Quality Measures for PCP/OB-GYN
Business: Medi-Cal Managed Care

Health Plan is pleased to announce the 2024 Provider Incentive Program 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
To participate in the Provider Incentive Program, practices must maintain a minimum of 50 Health Plan members and remain open to new members the entire calendar year until they reach capacity. OB-GYNs qualify for any applicable measure within their scope of practice.

PCPs can earn $75 – $100 for each qualifying member, based on
encounter/claim received for each of the 18 MCAS measures listed on page 2
of this notice.

Additional Incentives for Performance Improvement can be earned. If a measure increased in percentile from Calendar Year 2023, additional incentive amounts will be paid out in accordance with the table below. Incentive amounts are determined by level of achievement reached and are proportionate to the average number of assigned members during the calendar year.

*Incentive amounts for NCQA HEDIS rate improvement

No. of Assigned Members 25th to 33rd Percentile 33rd to 50th Percentile 50th to 66th Percentile 66th to 75th Percentile or above
1000 – 1999 $1000 $2000 $3000 $5000
2000 – 3999 $2000 $3000 $4000 $6000
4000 – 5999 $3000 $4000 $5000 $7000
6000+ $4000 $5000 $6000 $8000

*Per measure up to a maximum of 10 measures
Health Plan will incentivize provider performance on the following 18 target measures:

2024 Incentivized Quality Measures

# Behavioral Health Domain Measures ACRONYM INCENTIVE
1 Follow-Up After ED Visit for Mental Illness – 30 days FUM $100
2 Follow-Up After ED Visit for Substance Abuse – 30 days FUA $100
# Childrens Health Measures ACRONYM Incentive
3 Child and Adolescent Well-Care Visits WCV $100
4 Childhood Immunization Status: Combination 10 CIS-10 $100
5 Developmental Screening in the First Three Years of Life DEV $100
6 Immunizations for Adolescents: Combination 2 IMA-2 $100
7 Lead Screening in Children LSC $100
8 Well-Child Visits in the First 30 Months of Life – 0 to 15 Months – Six or More Well-Child Visits* W30-6+ $75
9 Well-Child Visits in the First 30 Months of Life – 15 to 30 Months –Two or More Well-Child Visits* W30-2+ $75
# Chronic Disease Management Measures ACRONYM Incentive
10 Asthma Medication Ratio AMR $75
11 Controlling High Blood Pressure CBP $100
12 Hemoglobin A1c Control for Patients With Diabetes – HbA1c Poor Control (> 9%) HBD $100
# Reproductive Health Domain Measures ACRONYM Incentive
13 Chlamydia Screening in Women CHL $75
14 Prenatal and Postpartum Care: Postpartum Care PPC-Pst $75
15 Prenatal and Postpartum Care: Timeliness of Prenatal Care PPC-Pre $75
# Cancer Prevention Measures ACRONYM Incentive
16 Breast Cancer Screening BCS-E $100
17 Cervical Cancer Screening CCS $100
18 Colorectal Cancer Screening COL $75

Virtual Look and LearnIf 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

Posted on March 1st, 2024 and last modified on March 3rd, 2024.