Pay-For-Performance (P4P) Program
Each year, Health Partners Plans develops Pay-for-Performance (P4P) incentives for our providers, based on specific initiatives that improve the health outcomes of our members. While ultimately benefiting our members, these incentives also offer an opportunity to increase revenue to your office.
Quality Care Plus
Quality Care Plus is a consolidated incentive program designed to reward positive performance by primary care practices in our network throughout the year.
Quality Care Plus Manual: Updated annually, the QCP Manual highlights what you need to know to understand and maximize your incentive payments. Participating providers can obtain a copy of the manual by contacting their Network Account Manager directly.
If you are not a participating provider and wish to see the details of this program, please contact Health Partners Plans at 1-888-991-9023.
Maternity Quality Care Plus
The Maternity Quality Care Plus (MQCP) is a specialty incentive program designed to recognize and reward maternity care providers’ quality performance. First implemented in 2016, MQCP incentivizes the maternity measures in the Healthcare Effectiveness Data and Information Set (HEDIS) dataset and the Pennsylvania Department of Human Services’ (DHS) metrics regarding cesarean-section (C-section) rates and timely submission of all parts of the Obstetrical Needs Assessment Form (ONAF).
Licensed providers (nurse midwives, OB-GYNs, CRNPs, PCPs, etc.) must meet the following criteria in order to participate in the MQCP Program:
- Accept new HPP members
- Have a minimum of 15 deliveries during the annual reporting period.
To learn more, please contact your Network Account Manager or call 1-888-991-9023.
Pregnancy Hot Topics and Resources
HPP has developed a Pregnancy Hot Topics and Resources guide that provides additional information and resources that may be helpful in supporting your patients, our members, in achieving a healthy pregnancy, delivery and postpartum care.
Pregnancy Hot Topics and Resources
ONAF Reimbursement Program
Measurement Year 2023
HPP has implemented a new reimbursement program for the submission of Obstetrical Needs Assessment Forms (ONAF). The incentive is available to all OB providers in HPP’s network and went into effect on January 1, 2023.
Effective for the 2023 calendar year, the ONAF measure will be removed from the Maternity Quality Care Plus (MQCP) program. In the new ONAF program, providers will be eligible for a maximum of $200 total incentive for submission of one complete prenatal and one complete postpartum ONAF form. All ONAFs must be submitted and accepted electronically via Optum. Providers will receive payments quarterly.
|
Form |
Reimbursement |
|
Prenatal/Initial ONAF* |
$125.00 |
|
Postpartum/Final ONAF |
$75.00 |
* Must be submitted within 7 days of initial prenatal visit.
HPP relies on your prompt submission of the Obstetrical Needs Assessment Form (ONAF) to enroll Medicaid members into our Baby Partners program and collect important clinical and quality data. Please note that rejected ONAFs will not be paid unless corrected and re-submitted within the appropriate timeframe. We are excited about this new incentive and will work with you to help implement it for your practice.
Measurement Year 2022
For measurement year 2022, the ONAF was included as a quality measure in the Maternity Quality Care Plus incentive program for OB providers. Results for MY 2022 are recalculated in April 2023 and a new payment cycle, that includes incentive payments based on the percentage of your eligible members for which a completed ONAF was submitted, begins in May 2023 through April 2024. Incentive payments are based on how well your practice meets predefined benchmarks. Providers that meet one of two benchmark tiers, Good Performers (Tier 1) and Highest Achievers (Tier 2), will earn incentives for the ONAF measure as part of their MQCP payments. Moving forward, the measure has been removed from MQCP.
If you have additional questions, please reach out to your Provider Relations Representative or contact our Provider Services Helpline at 1-888-991-9023, Monday – Friday, 9 a.m. – 5:30 p.m.