Federally Qualified Health Centers
& Rural Health Centers

Opportunity to Improve Quality for Your Patients

Health Plan of San Joaquin builds healthier communities by investing in prevention. We have tools to help you identify your HPSJ Medi-Cal patients due for services. Our Provider Services team will partner with your staff to achieve optimal results.

Thank you in advance for your support in improving health and potentially reducing preventable diseases in our members. Schedule your patients for preventative services today and increase your earning potential!

Federally Qualified
Health Centers (FQHC)

2024 Incentive Brochure

2024 Incentive Letter

2023 Participation Requirements

FQHC	RHC
Maintain a minimum of 500 HPSJ members collectively The clinic(s) must remain open to new members for the entire calendar year	Maintain a minimum of 50 HPSJ members collectively Clinic(s) must remain open to new members for the entire calendar year

Why Partner with HPSJ?

Join our Network!

Which measures are incentivized?

2023 Quality Improvement Measures – HEDIS®

Behavioral Health Domain Measures
Follow-Up After ED Visit for Mental Illness – 30 Days (FUM)*	Follow-Up After ED Visit for Substance Abuse – 30 days (FUA)*

Children’s Health Measures
Child and Adolescent Well-Care Visits (WCV)*	Childhood Immunization Status: Combination 10 (CSI-10)*
Developmental Screening in the First 3 Years of Life (DEV)*	Immunizations for Adolescents: Combination 2 (IMA-2)*
Well-Child Visits in First 30 Months of Life: 0 to 15 Months, 6 or More Well-Child Visits (W30-6+)^	Well-Child Visits in First 30 Months of Life: 15 to 30 Months, 2 or More Well-Child Visits (W30-2+)^
Lead Screening in Children (LSC)

Chronic Disease Management Measures
Asthma Medication Ratio (AMR)^	Controlling High Blood Pressure (CBP)*	Hemoglobin A1c Control for Patients with Diabetes – HbA1c Poor Control (> 9%) (HBD)*

Reproductive Health Domain Measures
Chlamydia Screening in Women (CHL)^	Prenatal and Postpartum Care: Postpartum Care (PPC-Pst)^	Prenatal and Postpartum Care: Timeliness of Prenatal Care (PPC-Pre)^

Cancer Prevention Measures
Breast Cancer Screening (BCS-E)*	Cervical Cancer Screening (CCS)*	Colorectal Cancer Screening (COL)^

Incentive Budget

The funding pool available to each clinic is based on their member months during the calendar year.

10% of the total incentive pool will be earned if the FQHC/RHC increases the panel seen by 3% from the previous year
90% of the incentive pool will be equally divided among the 25 measures and paid in accordance to the percentile met

Program Qualifiers	Payment Description
Quality Measure totals for all assigned membership meets less than 25th percentile	No incentive payment will be paid
Quality Measure totals for all assigned membership meets the 25th percentile but less than 33rd percentile	Payment of 25% of the total budgeted amount for the measure will be paid
Quality Measure totals for all assigned membership meets the 33rd percentile but less than 50th percentile	Payment of 50% of the total budgeted amount for the measure will be paid
Quality Measure totals for all assigned membership meets the 50th percentile but less than 75th percentile	Payment of 100% of the total budgeted amount for the measure will be paid
Quality Measure totals for all assigned membership meets or above 75th percentile	Payment of 110% of the total budgeted amount for the measure will be paid
Members Seen – Year Improvement: 3% goal of members seen from previous year (CY 2022) will qualify for 100% of the allocated amount

Bonus Incentive

For organizations with total incentive pool of less than 1 million for the year:

If the organization meets the 50th percentile for 20 or more measures – it will earn an additional bonus incentive of $40,000.
If the organization meets the 50th percentile for 15 measures – it will earn an additional bonus incentive of $20,000.

For organizations with total incentive pool of more than 1 million for the year:

If the organization meets 50th percentile for 20 measures – it will earn an additional bonus incentive of $200,000.
If the organization meets 50th percentile for 15 measures – it will earn an additional bonus incentive of $100,000

Check to see if your HPSJ Patient is up to date with wellness visits here

Care GAP reports available on DRE Portal

Additional Incentives:
DHCS Value Based Payment
Primary Care Provider Incentive Program

If you have any questions please contact your HPSJ representative at 209.942.6340 or by email at ProviderServicesDepartment@hpsj.com.

Federally Qualified Health Centers & Rural Health Centers