Pay for Performance: QCP and MQCP
Each year, Jefferson Health 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. Jefferson Health Plans has two Quality Care Plus (QCP) programs, one for Primary Care Providers and the other for Maternity Care Providers. Both programs are designed to partner with providers to improve clinical quality and patient outcomes.
Quality Care Plus
Using standardized, industry accepted measures and our unique quality performance initiatives, QCP is used to support our shared mission of improving the health of our members and the communities we serve.
Wellness Rewards
Jefferson Health Plans will continue to offer Wellness Rewards, our Medicare member rewards program, to all Jefferson Health Plans Medicare members. Wellness Rewards incentivizes Medicare members to complete specific health-related activities to earn money on a reloadable card. Please note that our Medicare rewards program is different from our Medicaid/CHIP rewards program.
The Wellness Rewards medication adherence activities and preventive health screenings are tied to current Quality Care Plus (QCP) measures. Leveraging the Wellness Rewards program and encouraging your patients to complete these activities can help you improve your performance on these QCP measures. To ensure that your Health Partners Medicare patients are rewarded for their completed activities, please submit claims timely and accurately.
Please refer to the 2024 Medicare Wellness Rewards Program Letter in the provider portal for additional details and eligibility requirements, or visit HPPlans.com/rewards. If you have any questions about the Wellness Rewards Program, please contact your Provider Relations Representative.
QCP Resources
- Access Report Cards through our provider portal
MQCP
The Maternity Quality Care Plus (MQCP) is an incentive program designed to recognize and reward the quality performance of maternity care practices serving Health Partners (Medicaid) members.
MQCP Resources
- Jefferson Health Plans 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.
- Access Report Cards through HPP's provider portal
ONAF Reimbursement Program
Measurement Year 2024
Jefferson Health Plans has implemented a new reimbursement program for the submission of Obstetrical Needs Assessment Forms (ONAF). The incentive is available to all OB providers in our network and went into effect on January 1, 2023.
Last year, the ONAF measure was removed from the Maternity Quality Care Plus (MQCP) program. In this program, providers are 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.
Jefferson Health Plans 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.
Pediatric Shift Care Nursing Services Incentive Program
Home care agencies are eligible for two incentive opportunities, each paying a per member per year (PMPY) amount based on their results compared to benchmarks.