Providers are eligible to receive financial rewards for performance excellence and for performance improvement.
Financial rewards are based on a tiered system, providing increasing financial rewards as Providers reach each level of higher performance.
The 2023 GQ P4P Program incentive pool is $148 million for PCPs.
Payments within the core program will be awarded to PCPs based on individual performance in reaching established Quality Goals.
[R]esults are based on each measure’s total eligible population assigned to the PCP. The eligible population is defined as the set of Members who meet the denominator criteria specified in each measure…
For each measure, the measure score reflects the proportion of the eligible population that complies…
PCP performance for each quality measure will be given a point value (i.e., a Quality Score).
Providers who have at least three quality measures that meet the minimum denominator size (n = 20) will be considered for payment calculations. An overall weighted average of all eligible Quality Scores will determine the overall GQ Performance Score.
[C]hildhood immunizations… are given a weight of 3.
Childhood Immunizations (CIS) – Combo 10
Measure Description: The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); three haemophilus influenza type B (HiB); three hepatitis B (HepB); four pneumococcal conjugate (PCV); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The percentage of children 2 years of age who had one measles, mumps and rubella (MMR); one chicken pox (VZV); and one hepatitis A (HepA) vaccines on or between the child’s first and second birthdays. The measure calculates a rate for each vaccine and one combination rate.
– Combo 10 includes the timely completion of the following antigens: DTaP; IPV; MMR; HiB; HepB; VZV; PCV; HepA; Rotavirus; Flu
Immunizations for Adolescents (IMA) – Combo 2
Measure Description: The percentage of adolescents 13 years of age who had one dose of meningococcal conjugate; one tetanus, diphtheria toxoids and acellular pertussis (Tdap); and two or three doses of the human papillomavirus (HPV) vaccine on or before their 13th birthday. The measure calculates a rate for each vaccine and a combination rate.
Quality bonus payment to a Provider for each pediatric immunization administered for Members 0-18 years of age for antigens included in the Childhood Immunization Combo 10 (CIS) or Immunizations for Adolescents (IMA) measure.
– Payment based on antigen administered
– Payment to each rendering Provider who administered the pediatric immunization
– One payment per Member per antigen per date of service
Quality bonus payment to a Provider for each adult influenza vaccine administered for Members 19 years of age and older.