Primary Care Performance Payment Model
Thank you for being a valued participant in Martin's Point Generations Advantage and the US Family Health Plan.
Welcome to the Martin’s Point Primary Care Performance Payment Model resource page for providers participating in the Martin’s Point Generations Advantage and/or US Family Health Plan.
Here you’ll find details of the current year’s payment model—including updates to services eligible for payments, criteria for payments, and payment amounts.
The Payment Model Objective
Our model, based on HEDIS® guidelines, is designed to promote the highest-quality care for our health plan members by aligning financial incentives with the delivery of recommended preventive and behavioral health services.
Incentive payments are made quarterly and are separate from and in addition to applicable fee-for-service payments.
EFFECTIVE DATE: All updates and payment models described here are effective from January 1, 2024, to December 31, 2024.
Access the 2024 Payment Model
Includes details on eligibility, requirements, and payment amounts.
What’s New for 2024
The following items are new for 2024 and apply to both Generations Advantage and US Family Health Plan members. See the 2024 Payment Model above for eligibility and requirement details.
FAQs
As part of our commitment to provide clarity and support, we've compiled a list of FAQs that naturally follow from our 2024 updates. These aim to address common queries and provide additional insights into the new payment model.
Providers can maximize their earnings in several ways under the 2024 model, including:
1. Familiarize with New Additions
Stay informed about the new screenings and immunizations introduced for 2024. Ensuring adherence to recommended schedules for these preventive services is crucial.
2. Focus on Behavioral Health
Pay special attention to the expanded areas of behavioral health. This includes understanding the criteria for post-discharge follow-up visits and ensuring these are conducted when applicable.
3. Use Custom Quarterly Reports
Each quarter, we will provide you with a custom report which outlines your progress in the previous quarter towards achieving available performance payments and highlights all remaining opportunities to earn.
4. Proactive Patient Outreach
Use the information from these reports to proactively reach out to patients. Scheduling patients for recommended services, especially those outlined in the new updates, can significantly contribute to maximizing your earnings.
5. Regular Review of Member Health Needs
Continuously assess the health needs of our health plan members. Aligning your practice's services with these needs not only enhances patient care but also aligns with the performance payment model’s objectives.
All payments for the fourth quarter of 2023 are planned for disbursement in March 2024. This includes two key components:
1. Regular Q4 Payments
These are for claims processed by December 31, 2023. They represent the standard payments for services rendered in the last quarter of the year.
2. Final Adjustment Payment
To account for any late-arriving claims or adjustments, a final payment will be made in March 2024. This ensures that all eligible services provided in 2023 are fully and fairly compensated, accommodating any claims that may have been processed after the year-end.
The incentive measures are based on HEDIS® guidelines and have been carefully selected to align with key areas of focus for primary care, preventive health, and behavioral health.
These measures are regularly reviewed to ensure they stay relevant to current health care priorities and needs.
Providers can access the detailed 2024 Primary Care Performance Payments Model (PDF) for in-depth information.
Additionally, our Network Management team is always available for personalized assistance and queries.