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