Pay for Performance Criteria
To participate, a PCP must have:
- PCP Membership: >50 (AIPA/LIPA) and >15 (SMIPA)
- PCP Encounter Submission must be at least 1.0 (claims must be submitted within 90 days of date of service)
- Incentive Payments are discretionary and determined and paid only after considering profitability and solvency requirements of the IPAs.
- P4P
20% | Exclusivity |
15% | Re-Admits Rate (30 days) |
15% | ER Visits |
10% | Encounters |
10% | Admits/K (hospital) |
10% | Membership Retention |
10% | Care Coordination |
5% | After Hours Access |
5% | Same Day Appts |
100% |
- RISK ADJUSTMENT
70% | Risk Score |
15% | Annual Wellness Visit |
15% | No HCC patients |
100% |
Separate pool from increases in capitation due to risk adjustment scores
III. SUPER EXCLUSIVE
Separate pool available to PCPs with super exclusive status.