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.
  1. 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%  
  1. 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.