Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans.

We have important information to share about our Quality Care Plus (QCP) program, including an overview of updates for the 2025 QCP program.

2025 QCP Program Updates

Our QCP program rewards your practice’s performance for delivering quality services to our members. Each year, we assess the program to ensure that it positively affects our members and providers. We typically add and remove measures, as well as adjust the benchmarks and payment amounts based on historical performance, network performance, NCQA benchmarks, and CMS Stars benchmarks.

The changes outlined below will impact the 2025 measurement year (January 1 through December 31, 2025) and payments beginning in May 2026 (unless otherwise noted). Further clarification about how membership is calculated will be included in the QCP Manual.

Overall Program Changes

1. Eligibility Requirement: Effective for the 2025 measurement period, providers will now be required to see at least 30% of paneled Medicaid members during the 2025 measurement year to participate and earn any incentive dollars for Medicaid measures beginning with the May 2026 payment cycle. Only members enrolled for at least 10 months at the site during the measurement year and remaining enrolled as of December 31 of the measurement year will be included in the rate calculation. Telehealth visits are allowed and will count toward the visit rate. This requirement impacts the Medicaid line of business only and will not affect the CHIP, Medicare Advantage, or Individual and Family Plans lines of business. This is a 5% increase from the previous years’ eligibility requirement; however, providers were given advanced notice of this planned increase as outlined in the 2024 QCP Manual and communicated throughout the year.
2. Payment Calculation at the TIN Level: Effective for the 2024 measurement period (payments beginning in May 2025), providers will be measured and paid at the overall Tax Identification Number (TIN) level rather than the individual supplier location level. Providers will no longer need to meet a supplier location minimum membership threshold of 50 members. Only the TIN minimum membership threshold of 100 members must be met to participate.
3. PMPMs based on Monthly Membership: Effective for the 2025 measurement period, incentives will be paid using a per member per month (PMPM) calculation, which is based on the current paneled membership of the practice every month.

2025 Quality Measure Changes

• Annual Wellness Visit*: This new Medicare measure will look at the percentage of Medicare members who had their annual wellness visit (preventive visit covered by Medicare) completed during the measurement year. Since this is not a Stars measure, we created custom benchmarks for this measure based on historical network performance.
• Care of Older Adults: In 2024, we included Medication Review and Pain Assessment as separate, stand-alone measures. In 2025, Functional Status Assessment will replace Pain Assessment. Functional Status Assessment and Medication Review will continue to be measured separately as stand-alone measures for Medicare only. Official CMS cut points are not available since Functional Status Assessment is a returning measure to the Stars program. Benchmarks will be based on historical network performance.
• Kidney Health Evaluation for Patients with Diabetes*: This new Medicare measure will look at the percentage of members 18-85 years of age with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR), and a urine albumin-creatinine ratio (uACR), during the measurement year. Please note that members must complete both tests to be considered compliant for this measure.
• Oral Evaluation, Dental Services: This Medicaid only measure will be removed from the QCP program effective measurement year 2025. Dental providers will continue to be incentivized via our Dental P4P Program. 

*Provider resource guides for these measures can be found on the Quality page of our website: HPPlans.com/stars. Additional details will also be provided in the 2025 QCP Manual.

Please click here for the complete list of the Medicare, Medicaid, and CHIP measures included in the 2025 program.

For More Information

The updated 2025 QCP Manual is expected to be released at the end of the year and will include all appropriate information. The 2025 QCP manual will be available at HPPlans.com/QCP.

Your Provider Relations Representative will be working closely with you to ensure that your office understands these changes and to answer any questions. You can also contact our Provider Services Helpline at 1-888-991-9023, Monday to Friday, 9 a.m. to 5:30 p.m.

Thank you for your continued support in helping improve the health outcomes of our members.