Physician Pay-for-Performance Program Manual

This document is a program manual for the Physician Pay-for-Performance (P4P) Program by L.A. Care Health Plan, specifically for Measurement Year 2025. It outlines the program's objectives, which include providing financial rewards to primary care physicians and community clinics for delivering high-quality care to L.A. Care members. The manual details eligibility criteria for participation, which require a minimum number of assigned Medi-Cal members. It also describes the performance assessment methods, including the use of Healthcare Effectiveness Data and Information Set (HEDIS) measures. Changes for Measurement Year 2025 are highlighted, including the exclusion of certain Medi-Cal members from the program and updates to payment measures. Additionally, it explains the process for data submission and the calculation of incentive payments, emphasizing the importance of encounter data in determining performance scores. The manual serves as a comprehensive guide for eligible providers to understand their participation in the program.