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.