Pay-for-Quality (P4Q) Program

Medical Pay-for-Quality Program

The medical Pay-for-Quality (P4Q) Program creates incentives and disincentives for managed care organizations based on their performance on certain quality measures. Health plans that excel on meeting the at-risk measures and bonus measures may be eligible for additional funds while health plans that don’t meet their at-risk measures can lose up to 3 percent of their capitation rate. The redesigned medical P4Q program became effective January 1, 2018. Measures, methodology, and performance targets are outlined in the Uniform Managed Care Manual, Chapter 6.2.14.

Dental Pay-for-Quality Program

Effective January 1, 2018, a total of 1.5 percent of each DMO’s capitation will be at risk for performance on three measures in Medicaid and CHIP. If a plan does not improve or decline beyond a set threshold, it will retain all of its capitation. However, if one dental plan declines in performance resulting in a recoupment, the money may be available as an incentive to the other dental plan. The second plan would only be able to earn this money if its performance improves enough to earn these additional dollars.

Measures, methodology, and performance targets are outlined in the Uniform Managed Care Manual, Chapter 6.2.15.

Medicaid and CHIP Dental Measures

For more information, email MCD Managed Care Quality