Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) builds healthier communities by investing in prevention. We have tools to help you identify your 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 the health and potentially reducing preventable diseases in our members. Schedule your patients for preventative services today and increase your earning potential!
| 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)^ |
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 Improvement — Additional incentives can be earned for up to 10 measures that improved at least 3 to 5 percentile points compared to Calendar Year 2023 in the following domains:
| Program Qualifiers | Payment Description |
|---|---|
| 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 assigned members meets 25th percentile but less than 33rd percentile | Payment of 30% of the total budgeted amount for the measure |
| Quality Measure total rate result for assigned members meets 33rd percentile but less than 50th percentile | Payment of 60% of the total budgeted amount for the measure |
| Quality Measure total rate result for assigned members meets 50th percentile but less than 66th percentile | Payment of 100% of the total budgeted amount for the measure |
| Quality Measure total rate result for assigned members meets or surpasses 66th percentile | Payment of additional $10,000 for the measure (up to 10 measures total) |
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 April 22nd, 2024.
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