Quality Incentive Programs

Quality Incentive Programs

PCP Dental Incentive Program

Reminder: 
There is a dental incentive plan for YourCare members 2-20 years of age. These members are required to receive a dental visit by their assigned dentist at least once per year.

The basic design of the program is for Healthplex to provide Primary Care Professionals such as yourself a listing of all members assigned to your office who have not had a dental visit in 2018. This incentive program will run from June 1, 2018 - December 31, 2018. You will receive an incentive bonus of $5.00 for each member you see and recommend that they visit their dentist, and you will receive an additional $15.00 for each of those members who actually visit the dentist this calendar year.

Healthplex will set aside a $5.00 incentive bonus for each referral made. When the patient visits his or her dentist, an additional $15.00 bonus will also be set aside for you. For every patient on this list who you refer to the dentist who actually goes to the dentist in 2018 after you make the referral, you have the opportunity to receive $20.00. A cumulative payment will be made to you in the second quarter of 2019.

Both YourCare and Healthplex are extremely optimistic about this initiative. In past years, it has proved to be a simple and timely way to improves this population's access to dental care, and we expect it will be successful this year as well.

We appreciate your cooperation. Should you have any questions, please contact Aisha Thomas-White RDH, Healthplex Quality Improvement Analyst, at 1.516.870.1352 or AWhite@Healthplex.com. Please copy Stuart Klatz, Outreach Associate, on all emails, Stuartk2@healthplex.com

 

Healthy Beginnings Prenatal Quality Incentive Program

This program recognizes the delivery of high quality care by our valued prenatal providers. This program is directed at the HEDIS/QARR standards established by NCQA and the New York State Department of Health. The information that is provided through this program enables us to follow our members from prenatal through postpartum care. The Healthy Beginnings Prenatal Quality Incentive Program will pay up to $450.00 per member based on accurate completion and timely submission of one of the WNY Collaborative Prenatal Care Risk Screening and Referral Forms below and the Healthy Beginnings Perinatal/Postpartum Encounter Form. For additional details please refer to our Healthy Beginnings Prenatal Quality Incentive Program Provider Bulletin.

Value Based Quality Incentive Program

 

At YourCare Health Plan, we believe you should be rewarded for helping patients live healthier. That’s why we’ve designed our Value Based Quality Incentive Program. To reward and recognize practitioners who provide high-quality, cost-effective care to their patients and submit accurate health data reflecting that care.

 

YourCare’s Value Based Quality Incentive Program is based on a shared savings model which promotes a goal we all support: quality healthcare for individuals and families who are served by government-sponsored programs. YourCare Health Plan is committed to this incentive program and will work with you and your staff to help you realize its full potential.

 

Working together, we can promote healthier individuals and families.

For measure specific information please see the Value Based Quality Program Measure & Tip Sheets:

Measure Sheet-Pediatric

Measure Sheet-Adult/Peds

Tip Sheet- Adolescent Preventive Care (NYS-APC)

Tip Sheet-Weight Assessment and Counseling for Nutrition and Exercise (WCC)

 


Committed to Your Success

YourCare Health Plan will generate monthly reports based on claim data, which provide practices with a scorecard to indicate progress.

If you’re concerned your practice doesn’t have the resources to participate in the program, we can help. YourCare Health Plan is committed to helping all participating practices through education and training programs, including:

  • Value Based Quality Incentive Program Team members leverage NYS Quality Measures that can be most effectively improved via support for and collaboration with primary care practices and providers. The program includes practice-specific data-analytical support and coding analysis/education. The goal is to target and impact the preventive and follow-up visits that are most likely to improve members’ healthcare.
  • Please contact Wanda Maxwell at 585-256-8487 or wmaxwell@yourcarehealthplan.com for additional information.


Have more questions?

For more information, please contact our Quality Matters team. We’ll schedule a meeting to review the program in more detail and discuss the potential bonus reward for your practice.

Quality Matters Team