McLaren Health Plan
Incentive Programs

I. Introduction

McLaren Health Plan (MHP) is committed to providing high quality, cost effective health care to our membership. By establishing a Pay for Transformation (P4T) program, MHP builds a strong partnership with our contracted Primary Care Providers (PCPs) which results in improved access and care coordination of health care services for our members. The P4T program provides incentives that optimize transformation activities, care coordination and quality by recognizing the outstanding efforts of our PCPs. The ultimate goal of the program is to improve health care outcomes.

II. General Terms

A PCP can receive up to $2 per member per month (pmpm). This is awarded based on HMO membership as of the end of the calendar year. The actual award is subject to the following conditions for the measurement year:

1. The PCP must be contracted with MHP for at least six months of the measurement year and be contracted at the time of the payment.
2. The PCP must have an annual average of 50 members per month.
3. The PCP must be in an open acceptance status throughout the measurement year to be included in the P4Tprogram.
4. To be eligible, members must be assigned with the PCP for six months of the year.
5. The PCP must participate in all PPO and HMO products.
6. Ninety percent of all claims during the measurement year must be submitted electronically.

III. Measures, Specifications, Performance Goals and Award

The following table describes the program’s measures, specifications, goals and awards. Measures and awards are reviewed and goals are adjusted annually or sooner if warranted. Random audits of acceptance status will be performed throughout the measurement year.

A Quick Reference Guide is available that briefly explains the P4T program. The Quick Reference Guide displays the key elements of the program and is separate from this program description.

IV. Program Payment and Distribution

The program calculation and payments will be made as follows:

1. Determine the score for each measure based on MHP specifications
2. Compare against set goal for measurement year
3. Calculate award pmpm for membership (Medicaid and Community) as of 31 of the measurement year

The payment schedule will be within six months of the end of the next measurement year. Payments will be made to the individual primary care provider, or as the physician group directs.

V. Contact Information

Please contact your Provider Relations Representative at 888-327-0671 (TTY: 711) for full program details, including qualifying requirements and payment distribution.

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2024 Provider Incentive Program

McLaren Health Plan (MHP) is committed to providing high quality, cost-effective health care to our membership. By establishing a Primary Care Physician (PCP) Incentive Program, MHP builds a strong partnership with our contracted PCPs, resulting in improved access to health care services for our members.

The PCP Incentive Program, outlined below, provides incentives that optimize transformation activities, care coordination and quality by recognizing the outstanding efforts of our PCPS while improving health care outcomes.

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For Community and Medicaid members ages 21-64

The Cervical Cancer Screening Incentive program is designed to reward and recognize McLaren Health Plan’s (MHP) Primary Care Providers (PCP) for excellent quality care.

As an incentive for meeting NCQA compliance rates, MHP will reimburse you for each member you see, as described below:

	NCQA 75th Percentile	NCQA 90th Percentile
Medicaid	62.53% Overall Compliance Rate	66.88% Overall Compliance Rate
Community	78.36% Overall Compliance Rate	81.67% Overall Compliance Rate
	$25 per member	$50 per member

In order to receive your incentive payment for each of your members ages 21-64, the member must be seen by Dec. 31 in the measurement year. You must submit a claim to MHP using HCPCS/CPT codes by March of the following year.

PAP: 88141-88143, 88147-88148, 88150, 88152-88154, 88164- 88167, 88174-88175, G0123-G0124, G0141, G0143-G0145, G0147-G0148, P3000-P3001, Q0091

HPV: 87620-87622, 87624-87625, G0476

Your current-year incentive payment will be distributed in the spring of the following calendar year.

We look forward to your partnership and collaboration with the Cervical Cancer Screening Incentive and other endeavors to increase quality outcomes.

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For screening Community and Medicaid members

This chlamydia screening program is designed to reward and recognize McLaren Health Plan’s (MHP) Primary Care Providers (PCP) who meet the requirement of performing/ ordering a chlamydia screening annually for female members ages 16-24 and male members ages 16-18. As an incentive for your cooperation with screening identified members, MHP will reimburse you as described below:

Procedure Code: 87110, 87270, 87320, 87810, 87490-87492

McLaren Health Plan Incentive: $25

You will receive a $25 payment for each of your assigned MHP female members ages 16-24 and male members age 16-18 who receive a chlamydia screening as identified by the procedure codes listed above. Your current-year incentive payment will be distributed in the spring of the following calendar year. We look forward to your partnership and collaboration with the Chlamydia Screening Incentive and other endeavors to increase quality outcomes.

Thank you for the quality care you deliver!

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For Medicaid members ages 1 -14 years

Club 101 is an incentive plan designed to reward and recognize McLaren Health Plan’s (MHP) Primary Care Providers.*

For every well child visit performed and billed to MHP for Medicaid members ages 1-14, MHP will reimburse you $101.

Preventive Visit E&M Procedure Code	Medicaid Reimbursement	McLaren Health Plan Reimbursement
99392 Established patient, ages 1-4	$73.74	$101
99393 Established patient, ages 5-11	$72.79	$101
99394 Established patient, ages 12-17	$80.39	$101
99382 New patient, ages 1-4	$93.36	$101
99383 New patient, ages 5-11	$91.46	$101
99384 New patient, ages 12-17	$99.37	$101

We look forward to your partnership and collaboration with Club 101 and other future endeavors to increase quality outcomes.

*Primary Care Physicians in a capitated payment arrangement with McLaren Health Plan are not eligible for Club 101.

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For screening Community and Medicaid members

This Diabetic Core Measures program is designed to reward and recognize McLaren Health Plan’s (MHP) Primary Care Providers who meet the HEDIS® requirement for completing diabetic core measures every year for MHP Community and Medicaid members with diabetes, ages 18-75. MHP will reimburse you as described below:

Complete All Services	McLaren Health Plan Incentives
1. HbA1c test 2. Estimated glomerular filtration rate (eGRF) & urine albumin-creatinine ration (uARC)	$50
Diabetic Management 1. Controlled blood pressure <140/90 2. Controlled A1C <8	$25 for each controlled measure

For each of your MHP Community and Medicaid members with diabetes, ages 18-75, who receive recommended services as identified by the list above, you will receive a $50 payment. If their diabetes is appropriately controlled with an A1c below 8 and blood pressure below 140/90, you will receive an additional $25 for each controlled measure.

Your current-year incentive payment will be distributed in the spring of the following calendar year.

We look forward to your partnership and collaboration with the Diabetic Core Measures Incentive and other endeavors to increase quality outcomes.

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Completion of Child and Adolescent Immunization Combo by the 2nd or 13th birthday.

This healthy child immunization incentive is designed to reward and recognize our Primary Care Providers (PCPs).

As an incentive for your participation in this program, MHP will reimburse you annually for each eligible MHP or MHP Community member as described below:

Immunization Combo	Immunizations Included	MHP Incentive
Childhood Immunization Combo 3	DTaP, IPV, MMR, HiB, HepB, VZV, PCV	$50
Childhood Immunization Combo 10	DTaP, IPV, MMR, HiB, HepB, VZV, PCV, HepA, RV, Influenza	$100
Adolescent Immunization Combo 2	Meningococcal, Tdap, and HPV	$50

In order to receive the incentive for each of your eligible members, simply follow these steps:

• Bill for your administration of these immunizations
• Report completed immunizations through MCIR
• If member had immunizations outside of Michigan, submit medical records to MHPQuality@mclaren.org

You are eligible to receive one completed immunization combination incentive per child. Your current year incentive will be distributed in the spring of the following calendar year.

We look forward to your partnership and collaboration with the Healthy Child Immunization Incentive and other future endeavors to increase quality outcomes.

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For Medicaid members ages 0-3 years

This healthy screening is an easily achievable, simple incentive plan designed to reward and recognize McLaren Health Plan’s (MHP) Primary Care Providers (PCP).

As an incentive for your cooperation in this screening endeavor, MHP will reimburse you annually for each assigned MHP member as described below:

Annual Screening Test Reimbursement	CPT Code	ICD Code	MHP
Documented Developmental Screening	96110	Z13.4	$20

For each of your MHP Medicaid members that presents to your office, simply perform and document a developmental screening. In order to receive your incentive payment, submit a claim to MHP using the identified CPT code and corresponding diagnosis code. As a MHP contracted PCP you are eligible to receive one $20 incentive per child annually.

We look forward to your partnership and collaboration with Healthy Child Incentive - Developmental Screening and other future endeavors to increase quality outcomes.

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BMI/BMI Percentile; Counseling for Nutrition and Counseling for Physical Activity for assigned Community and Medicaid members ages 3-17.

BMI/BMI Percentile; Counseling for Nutrition and Counseling for Physical Activity for assigned Community and Medicaid members ages 3-17.

This healthy child Screening incentive is an easily achievable, simple program. It is designed to reward and recognize our Primary Care Providers (PCPs).

As an incentive for your cooperation in this screening program, MHP will annually reimburse you for each eligible MHP or MHP Community member as described below:

Annual Screening Tests	CPT Code	HCPCS Code	DX Code	MHP Incentive
Documented BMI/BMI Percentile			Z68.51-Z68.54	$5
Documented Counseling for Nutrition	97802, 97803, 97804	G0270; G0271; G0447; S9449; S9452; S9470	Z71.3	$5
Documented Counseling for Physical Activity			Z71.82, Z02.5	$5

In order to receive the incentive for each of your eligible members, simply follow these steps:

• Calculate and document their BMI/BMI percentile
• Annually document and counsel for nutrition and physical activity
• Submit a claim to MHP using the identified CPT/HCPCS codes or diagnosis (DX) codes

As an MHP and/or MHP Community contracted PCP, you are eligible to annually bill for and receive one $15 incentive per child.  Incentives will be dispensed in the Spring of the following year.

We look forward to your partnership and collaboration with the Healthy Child Screening Incentive and other future endeavors to increase quality outcomes.

We thank you for the quality care you deliver!

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For Medicaid Members

This lead screening program is an easily achievable, simple incentive plan. It is designed to reward and recognize McLaren Health Plan’s (MHP) Primary Care Providers who meet the MDHHS requirement of lead testing children before their second birthday.

As an incentive for your cooperation in this lead screening endeavor, MHP will reimburse you as described below when you provide a lead test to a MHP Medicaid member.

Procedure Code	McLaren Health Plan Medicaid Reimbursement
36416 Collection of a capillary blood specimen for lead test	$15
83655 If you have the capability to perform the lead test in your office	$25

We look forward to your partnership and collaboration with Lead Testing and other future endeavors to increase quality outcomes.

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For Community and Medicaid Members

This mammogram screening program is designed to reward and recognize MHP’s Primary Care Providers who meet the HEDIS® requirement of ordering a mammogram every two years for MHP Community and Medicaid female members ages 50-74.

For each of your MHP Community and Medicaid female members age 50-74 who receive a mammogram screening using the following procedure codes, you will receive $50.

Procedure Code	McLaren Health Plan Incentive
77061-77063 77065-77067	$50

Your current year incentive payment will be distributed in the spring of the following calendar year.

We look forward to your collaboration on the mammogram screening program and to your continued partnership to increase quality outcomes.

Thank you for the quality care you deliver!

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For Community and Medicaid members

This incentive is designed to reward and recognize McLaren Health Plan’s (MHP) OB-GYN and Primary Care Providers who meet the requirement of providing timely prenatal care within the first trimester AND a timely postpartum visit within 7-84 days of an MHP Community or MHP Medicaid mom’s delivery.

McLaren Health Plan Incentive: $100

To ensure appropriate payment of your incentive, bill the prenatal and postpartum visits to MHP.

Your current-year incentive payment will be distributed in the spring of the following calendar year.

We look forward to your partnership and collaboration with the Timeliness of OB Care Incentive and other endeavors to increase quality outcomes.

Thank you for the quality care you deliver!

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For Medicaid Members

This tobacco cessation counseling program is designed to reward and recognize McLaren Health Plan primary care providers.

As an incentive for your participation, MHP will reimburse you as described below when you provide smoking and tobacco use cessation counseling to a McLaren Health Plan Medicaid or HMP member.

Procedure Code Reimbursement	Incentive
99407 — Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes	$20
99406 — Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes	$12

Primary ICD-10 diagnosis of F17.200-F17.299 is required on submitted claims.

We look forward to your partnership and collaboration with Tobacco Cessation Counseling and other endeavors to increase quality outcomes.

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