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.
|15%||Re-Admits Rate (30 days)|
|5%||After Hours Access|
|5%||Same Day Appts|
- RISK ADJUSTMENT
|15%||Annual Wellness Visit|
|15%||No HCC patients|
Separate pool from increases in capitation due to risk adjustment scores
III. SUPER EXCLUSIVE
Separate pool available to PCPs with super exclusive status.