Pay for Improvement Incentive
A new and additional component of the 2025 Population Health Model program
The Pay for Improvement Incentive is designed to:
- Award payment to independent PCPs and FQHCs for achieving +5 percentage points improvement in three key Population Health Model (PHM) measures (i.e.,from 30% to 35%)
- Medicare Annual Wellness Visits
- Hypertension: Controlling High Blood Pressure (HEDIS CBP)
- Follow Up After ED Visits for Patients with Multiple Chronic Conditions (HEDIS FMC)
- Award payment to OneCare Preferred Providers and Collaborators following the current PHM payment structure
- Increase ability to earn bonus dollars for practices who are further from targets
- Improve performance in the PHM overall
Eligibility for pay for improvement incentive payment:
- Participants must continue to meet all PHM accountabilities as outlined in: (PHM policy to be posted shortly)
- Pay for improvement payments are an additive bonus, OneCare Participants are eligible to earn the existing PHM bonus in addition to pay for improvement bonus
- Visit the PHM Payments section of the Provider Resource Center for details on the existing PHM bonus
Payment and Performance Periods:
- Baseline period: performance as reflected in January 2025 PHM report release
- Performance period: calendar year 2025
- Payment period: 2026, after full run-out, during the same time period as 2026 reconciliation payments
- The amount of the bonus for achieving +5 percentage points improvement: $21 per member per measure (for the year)
- For example, if a practice with 1,000 attributed lives (est. mid-year) met the improvement bonus in all three measures, the bonus earned would be 1,000 * $21 * 3 (measures) = $63,000
Questions? Need help?
Please direct any questions to: onecarequality@onecarevt.org.