HEALTHmattersMD

Each year the Health Plan of San Mateo (HPSM) updates program guidelines for incentives offered to primary care providers (PCPs). Guidelines for HPSM’s Care Gap Pay-for-Performance Incentive (“Care Gap P4P”) and Benchmark Pay-for-Performance Incentive “Benchmark P4P” have been updated. Below is a summary of key changes. 

For all participating providers

Participants in any primary care incentive (e.g., Care Gap P4P, Benchmark P4P, Medi-Cal Panel Engagement Capitation Bonus) must complete the HPSM Primary Care Incentive Enrollment Form annually.

Updates to Care Gap P4P 

• Guidelines and Stellar Value Unit (SVU) menus updated to be evergreen instead of annually time-bound. 
• Timeline added, including deadlines for claims and supplemental data submission. 

Updates to Benchmark P4P

Medi-Cal 

Family Practice Track (assigned member ages 000–999): 

• Colorectal Cancer Screening (COL) added as an incentive-eligible measure. 
• Depression Screening and Follow-up (12 years and older) (DSF-E) has been separated to reflect the two associated actions of screening and follow-up for a positive screen. Depression Screening (DSF-E Rate 1) is the incentive-eligible portion.*
• Eye Exam for Patients with Diabetes (EED) changed to a reporting-only measure. 

• Colorectal Cancer Screening (COL) added as an incentive-eligible measure.* 
• Substance Misuse Screening (SBIRT) changed to a reporting-only measure. 

Pediatric Track (assigned member ages 000–017, or similar): 

• Lead Screening in Children (LSC) added as an incentive-eligible measure. 
• Well Child Visit (15-30 months old) (W30 Rate 2) as an incentive-eligible measure.*
• Weight Assessment and Nutrition Counseling for Children (WCC Rate 2) changed to a reporting-only measure.
• Physical Activity Counseling for Children (WCC Rate 3) changed to a reporting-only measure. 

CareAdvantage 

• Minimum number of patients in the denominator changed to ten for the metric to be included in the composite quality score.*

^{* The same DSF-E measure change described in the Family Practice Track.}