Primary Care Physician Payment Model

The Martin’s Point Health Care (MPHC) Primary Care Payment Model aligns with the daily work of primary care offices, recognizing your commitment to providing patients with the best care possible. Effective January 1, 2019, earning opportunities are available in two categories:

1.) Primary Care Service Payments
Fee-for-service payment based on the MPHC-allowed amount (minus applicable cost-sharing).

2.) Primary Care Performance Payments
Quarterly payments for rendering particular services such as annual physicals to MPHC health plan members who have selected that provider as their Primary Care Provider. These payments are separate from, and in addition to, applicable fee-for-service payments.

The following is an overview of the upcoming changes effective January 1, 2019:

  • Chronic Condition Management (CCM):
  • For Generations Advantage and US Family Health Plan members with a confirmed diagnosis of asthma, COPD, coronary artery disease, diabetes, or heart failure, providers will be eligible for a $25 payment when you complete at least two office visits during the 2019 calendar year and include chronic condition documentation on the claim.
  • Diabetes Management Performance Payments:
  • For Generations Advantage and US Family Health Plan members with a confirmed diagnosis of type 2 diabetes, there are four ways for providers to earn separate, $100 payments (see PCP Payment Model Summary Grid for complete details).
  • Immunizations/Vaccines/STD Screens:
  • For Generations Advantage and US Family Health Plan members who qualify for these services administered during the measurement year, providers may be eligible for $25 payments (see PCP Payment Model Summary Grid for complete details).

    FAQs

    How can I maximize my earnings?
    Each quarter, we will send you a custom report showing any progress made during the previous quarter toward achieving available performance payments and all remaining opportunities to earn. Use this report to maximize your earnings! Consider reaching out to the patients listed to ensure they are scheduled for recommended services.

    When will I receive payment for the last quarter of 2018?
    Any payments due for Q4 2018 (claims processed prior to December 31, 2018) will be remitted in March 2019. To accommodate claims run-out time, there will be a final payment in March 2019 for any qualifying 2018 claims.

    How did you come up with these incentive measures?
    These are industry-standard measures—based on HEDIS® guidelines—which are widely regarded as key areas of focus for primary care physicians.

    What if I have few patients with the chronic conditions you’re focusing on?
    You can still earn incentives, above and beyond standard fee-for-service payments, for delivering annual physicals and vaccines to eligible members.

    For more information, please call our Network Management team at 1-207-253-6147.

    Forms and Documents