Medi-Cal P4P Core Measure Set
A majority of Medi-Cal managed care plans have embraced pay for performance (P4P) strategies to align financial incentives with provider performance; however, the existing programs vary substantially with very little alignment of measures across Medi-Cal P4P programs. While some variation is useful, there is an opportunity to build on demonstrated successes towards greater standardization across programs to enhance effectiveness, reduce duplication, decrease resource burden associated with the programs, and ensure comparability of results.
IHA is leading an effort among Medi-Cal plans and provider organizations to create a standardized measure set for all Medi-Cal P4P programs. The voluntary effort aims to “strengthen the signal” from plans to providers regarding high-priority measures, and to reduce measurement burden among providers working with multiple plans. IHA recruited an Advisory Committee, made up of representatives from Medi-Cal managed care plans, providers serving Medi-Cal beneficiaries, the Department of Health Care Services, and other stakeholders to support this work.
Over the first year of the project, IHA’s Advisory Committee reached consensus on a core measure set that all Medi-Cal plans could incorporate into their existing P4P programs and a menu of additional measures that plans can use to supplement the core measure set at the local level.