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!
| Measures | |
| Effective Jan 1, 2021 - Dec 31, 2021 | |
| Breast Cancer Screening (BCS) | Cervical Cancer Screening (CCS) |
| Controlling High Blood Pressure (CBP) | CDC-HBA1c Test (CDC-H9) Comprehensive Diabetic Care |
| Well-Child Visits (W30) | Well-Child Visits 3-21 (WCV) |
| Prenatal Visit (PPC-Pre) First routine prenatal care visit (within the time frame) | Postpartum visit (PPC-Post) 1-84 days after delivery |
| Immunizations for Adolescents Combination 2 | Childhood Immunization Status Combination 10 (CIS) |
| Acute Antidepressant Medication Management (AMM) | Continuation Antidepressant Medication Management (AMM) |
| Initial Health Assessment (IHA)- IHA is first 120 days after enrollment into the plan | |
Incentive BudgetFunding Pool per clinic will be allocated in the following manner:- Proportionate to the membership assigned - Distributed equally for each measure | |
| 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 | Payment of 25% of the total budgeted amount for the measure will be paid |
| Quality Measure totals for all assigned membership is greater than the 25th percentile and less than the 50th percentile | Payment of 40% of the total budgeted amount for the measure will be paid |
| Quality Measure totals for all assigned membership meets the 50th percentile | Payment of 50% of total budgeted amount for the measure will be paid |
| Quality Measure totals for all assigned membership is greater than the 50th percentile or above | Payment of 100% of total budgeted amount for the measure will be paid |
| Members Seen - Year over Year Improvement: 5% goal of members seen from Base Year (CY 2020) will qualify for 100% of the allocated amount. |
If you have any questions please contact your HPSJ representative at 209.942.6340 or by email at ProviderServicesDepartment@hpsj.com.
Posted on August 9th, 2021 and last modified on August 17th, 2021.
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