You’ll get paid for the P4P program before the end of the year. The prepayment program is the P4P program for 2020.
A P4P program pays you as HEDIS® gaps are closed in the measurement year. A prepayment program pays you in advance for those same measures closed in a year.
The P4P prepayment is calculated based on your 2019 HEDIS® incentive performance. Each measure has a specific incentive amount that is paid after a target score is achieved. The 25% increase for 2020 is a 25% increase in payment. It isn’t based on increasing the provider’s score by 25% and then calculating the payment.
The P4P prepayment can enhance quality of care by incentivizing providers to focus on preventive and screening services. We’ve also set up safety data sheets to automate reporting and increase performance-related incentives.
We won’t facilitate a reconciliation.
The 2020 P4P program is a one-time payout program offered throughout the 2021 reporting year.
We’ll continue to provide quality improvement, provider relations, pharmacy services, contracting services, community outreach and care management services to all our members and providers.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Aetna Better Health of Illinois is not responsible or liable for content, accuracy or privacy practices of linked sites or for products or services described on these sites. If you did not intend to leave our site, click or tap the "x" in the upper right-hand corner.
This link will take you to the main Aetna® Medicaid website (AetnaBetterHealth.com). Aetna Better Health of Illinois is not responsible or liable for this specific content.
This link will take you to the Aetna Better Health® of Illinois provider website. It contains information for health care professionals. If you don't want to leave the member site, click or tap the "x" in the upper right-hand corner.
This link will take you to the Aetna Better Health® of Illinois vendor website. It contains information for our vendors. If you don't want to leave the member site, click or tap the "x" in the upper right-hand corner.