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. HHSC suspended the pay-for-quality (P4Q) program for 2020 and 2021 because of the COVID-19 pandemic. Measures and methodology are outlined in the Uniform Managed Care Manual, Chapter 6.2.14. 2018 and 2019 P4Q results are available on the Texas Healthcare Learning Collaborative Portal.
Dental Pay-for-Quality Program
In the dental P4Q program 1.5 percent of each dental plan’s capitation is at risk of recoupment for performance measures in Medicaid and CHIP. If a plan does not improve or decline beyond a set threshold, it will retain all of its capitation. If a plan’s performance declines beyond the threshold, up to 1.5 percent of the plan’s capitation may be recouped by the agency. If a plan’s performance improves beyond the threshold, the plan can earn incentive payments. Incentive payments are only available when money is recouped from another plan.
Measures, methodology, and performance targets are outlined in the Uniform Managed Care Manual, Chapter 6.2.15.
HHSC suspended the dental P4Q program for 2020 and 2021 because of the COVID-19 pandemic.
Medicaid and CHIP Dental Measures
For more information, email MCD Managed Care Quality.