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Each year, we develop Pay-for-Performance (P4P) incentives for our providers based on specific initiatives that improve the health outcomes of our members. While ultimately benefiting our members, these incentives can also increase revenue for your office.
Learn more about the components of pay-for-performance within each section below.
Using standardized, industry accepted measures and our unique quality performance initiatives, QCP is used to support our shared mission with primary care providers to improve the health of our members.
The MQCP is an incentive program designed to recognize and reward the quality performance of maternity care practices serving our Medicaid members.
We have implemented a new reimbursement program for the submission of Obstetrical Needs Assessment Forms (ONAF). The incentive is available to all OB providers in our network, effective January 1, 2023.
The Medicare Annual Wellness Visit (AWV) is a preventive visit covered by Medicare at no cost to patients. An AWV is an opportunity to connect with patients and focus on issues that may be overlooked during other visits (i.e., sick visits, follow up visits). It is also an opportunity to remind patients about open care gaps and ensure that all vaccinations, screenings and other preventative services are current. We have developed provider and patient guides to assist you with these visits:
Every year, CMS administers the Health Outcomes Survey (HOS), which assesses the ability of an organization to maintain or improve the current physical and mental health status of its members. A random sample of our Medicare members receive the HOS between July and September. The results help evaluate how members view their current health status and if providers addressed their health concerns. Two years later, the same respondents receive a follow-up survey on maintaining or improving physical and mental health. See below for additional HOS resources available for download:
Our providers play a key role in improving member satisfaction scores and elevating member experience. Jefferson Health Plans and Health Partners Plans have identified two specific areas of member satisfaction related to provider visits that we're actively working to improve: getting needed care and getting appointments and care quickly. To improve our members' experience, we have implemented the following interventions:
- Post-visit surveys
- Implementation of a member satisfaction measure in QCP
- Member and provider focus groups
The Consumer Assessment of Healthcare Providers and Systems, commonly known as CAHPS, is considered the national standard for measuring and reporting on consumers’ experiences with health plans, providers and services provided. We are committed to working collaboratively with our in-network providers to improve CAHPS results and overall member experience.
The PCMH model of care includes key components such as: whole person focus on behavioral health and physical health; comprehensive focus on wellness, as well as acute and chronic conditions; increased access to care; improved quality of care; team-based approach to care management/coordination; and use of electronic health records (EHR) and health information technology to track and improve care.
Resources:
Social determinants of health (SDoH) are the conditions in the environment where people are born, grow, work, live and age. They include factors such as food security, housing stability, childcare needs, utility needs, economic stability, transportation needs, exposure to violence and education needs. SDoH data offer rich insights into external conditions impacting health — an especially important consideration in underserved populations that may require complex care.
Resources:
- SDoH Resource Guide (PDF)
- Commonly Used SDoH Resources (PDF)
Our Special Needs Unit (SNU) collaborates with providers to help your patients and our members get the services they need. Our SNU can help arrange follow-up care after a hospital stay, coordinate outpatient and home care, connect patients to community-based social services and more.
Referrals can be sent by calling 215-548-4797 or emailing ClinicalConnections@jeffersonhealthplans.com.
HEDIS is a group of measures that allow health plans to measure how well they are doing taking care of their members. There are 90 HEDIS measures that look at many different areas of care received from a health care practitioner.
Some of the HEDIS measures are measures in our QCP program. A few of the HEDIS measures can manifest as care gaps for your patients.
We offer resources called HEDIS Hints to our providers that include best practices, coding information and more details about key measures.
Coming Soon!
We are committed to ensuring providers are informed as to the various quality reports that may be available. Please click here for a downloadable reporting calendar.