HEALTHmattersMD

HPSM’s Care Gap Pay-for-Performance Incentive (Care Gap P4P) supports providers in identifying and closing care gaps for Health Plan of San Mateo (HPSM) patients through a web-based platform called the Stellar Health App. This platform offers real-time bonus payments by rewarding providers for individual actions (e.g., scheduling appointments) they take to close priority care gaps through annual and well visits, preventive screenings, immunizations and more. 

Updates and rate increases to the Care Gap P4P program

• Clinics are assigned to either the Family Practice and Adult Medicine Track or the Pediatric Track based on the age range of assigned members
• Stellar Value Units (SVU) for both tracks reflect a +20% increase to the prior base SVU structure;
• Newly added action centers: 
  • Chlamydia Screening for Patients 16-24 years of age (CHL)
  • Statin Therapy for Patients with Cardiovascular Disease (SPC) 
  • Statin Therapy for Patients with Diabetes (SPD)

HPSM maintains the following commitments to participating providers: 

• Clinics that opt in to Care Gap P4P in the 2025 calendar year (CY2025) will be eligible to receive a Benchmark P4P bonus payment prorated to the number of CY2025 calendar days prior to enrolling in Care Gap P4P. This ensures clinics are always covered under an incentive program. 
• HPSM will “make whole” clinics who earn less in CY2025 under Care Gap P4P compared to what their earnings would have been for the equivalent number of days under Benchmark P4P Measurement Year 2025.