Primary Care Performance Payment Model
Thank you for being a valued participant in our Martin’s Point Generations Advantage and/or our Martin’s Point US Family Health Plan. To support your efforts to provide the highest-quality care to our members, Martin’s Point offers primary care performance payments that promote the delivery of recommended preventive care services to our members. These quarterly payments are separate from, and in addition to, applicable fee-for-service payments we make.
Here you’ll find information about our 2023 Primary Care Performance Payment model. This lists the services that qualify for payment effective 1/1/2023, including the amounts and criteria for payment. Please note that all services eligible for payment in 2022 will remain eligible in 2023. However, for the upcoming year, we have added a focus on following up after an emergency department behavioral health visit.
As a reminder in 2022, we added a focus on women’s health screenings (including breast and cervical cancer screenings along with a new incentive payment for chlamydia screenings for those aged 16-24) and pediatric annual physical exams. Please see PCP Payment Model Summary Grid for complete details.
Behavioral Health Followup
- Post-Discharge Follow-up Behavioral Health
- For Generations Advantage and US Family Health Plan members 6 years of age and older with a principal diagnosis of mental illness or intentional self harm, who had a follow-up visit for mental illness after emergency department visit, providers will be eligible for a $75 payment during the 2023 calendar year
Women’s Health Screenings
- Breast and Cervical Cancer Screenings
- For Generations Advantage and US Family Health Plan members with at least one confirmed screening for breast or cervical cancer, providers will be eligible for a $25 payment during the 2023 calendar year (see PCP Payment Model Summary Grid for complete details).
- Chlamydia Screenings
- For Generations Advantage and US Family Health Plan members with at least one confirmed test for chlamydia, providers will be eligible for a $25 payment during the 2023 calendar year (see PCP Payment Model Summary Grid for complete details).
- Annual Physicals: Child/Adolescent Wellness Visits
- For Generations Advantage and US Family Health Plan members with a confirmed Well Child Visit (W30) or Child and Adolescent Well-Care Visit (WSV), providers will be eligible for a $25 payment during the 2023 calendar year (see PCP Payment Model Summary Grid for complete details).
FAQs
How can I maximize my earnings?
Each quarter, we will send you a custom report showing any progress made during the previous quarter toward achieving available performance payments and all remaining opportunities to earn. Use this report to maximize your earnings! Consider reaching out to the patients listed to ensure they are scheduled for recommended services.
When will I receive payment for the last quarter of 2022?
Any payments due for Q4 2022 (claims processed prior to December 31, 2022) will be remitted in March 2023. To accommodate claims run-out time, there will be a final payment in March 2023 for any qualifying 2022 claims.
How did you come up with these incentive measures?
These are industry-standard measures—based on HEDIS® guidelines—which are widely regarded as key areas of focus for primary care physicians.
What if I have few patients with the chronic conditions you’re focusing on?
You can still earn incentives, above and beyond standard fee-for-service payments, for delivering annual physicals and vaccines to eligible members.
For more information, please email our Network Management team at [email protected].