Incentives for Primary Care Providers
Care Gap Pay-for-Performance Incentive
The Health Plan of San Mateo (HPSM) Care Gap Pay-for-Performance Incentive (“Care Gap P4P”) provides a web-based platform summarizing health needs for HPSM patients, enabling providers timely insight to efficiently recognize and close care gaps. This platform offers real-time bonus payments rewarding providers for individual actions (e.g. scheduling appointments) to close priority care gaps through well visits, initial health appointments, preventive screenings, immunizations, and more. Enrolled providers gain access to programmatic support through HPSM and our administrative partner, Stellar Health.
All clinics enrolled in Care Gap P4P continue to be simultaneously eligible for Benchmark Pay-for-Performance (“Benchmark P4P”). Care Gap P4P and Benchmark P4P quality measures align and incentive structures are designed to enable Care Gap P4P earnings greater than or equal to that of Benchmark P4P. HPSM continues to calculate annual Benchmark P4P earnings for providers that satisfy relevant eligibility criteria, including those enrolled in Care Gap P4P. In rare instances where annual earnings are greater in Benchmark P4P, HPSM issues payment to reconcile the difference; see HPSM Care Gap P4P Incentive Guidelines for details.
To enroll in Care Gap P4P, providers first participate in an onboarding call with the Stellar Health team. Please contact [email protected] or your Stellar Health representative if you would like more information.
Current Care Gap P4P Materials
Program Guidelines include clinic eligibility, quality metric specifications, incentive earnings guarantee, and frequently asked questions (FAQ). Incentive amounts for actions completed to close care gaps are available within ‘Stellar Value Units’ documents.
Benchmark Pay-for-Performance Incentive
HPSM's Benchmark Pay-for-Performance Incentive (“Benchmark P4P”) is designed to improve outcomes by offering bonus payments to in-network primary care providers meeting performance targets for select quality metrics. HPSM shares assigned patient
population data with each primary care clinic. Providers utilize the eReports portal to access these data, obtaining information
to understand both individual patient care needs and current performance regarding population health metrics.
Contracted primary care clinics electing to participate in Care Gap P4P continue to be simultaneously eligible for Benchmark P4P.
Previous Benchmark P4P Materials
- Medi-Cal 2025 Benchmark P4P Incentive Guidelines
- CareAdvantage 2025 Benchmark P4P Incentive Guidelines
- 2025 P4P Attestation Template
- Medi-Cal 2020 Primary Care Benchmark P4P Program Webinar (recorded December 6, 2019) VIDEO | SLIDES
- CareAdvantage 2020 Primary Care P4P Program Webinar (recorded December 13, 2019) VIDEO | SLIDES
Medi-Cal Panel Engagement Capitation Bonus Incentive
Access to primary care is a key driver for managing the health of our shared patient population. HPSM recognizes the work providers do to engage assigned HPSM members at their clinics. Capitated clinics will be eligible to earn up to an additional 30% of capitation each month based on quarterly panel engagement.
Current Medi-Cal Panel Engagement Capitation Bonus Incentive Materials
Guidelines include clinic eligibility, panel engagement requirements, data and bonus timelines, and capitation rate bonus eligibility.