Provider Incentives

join2Primary Care Provider (PCP) incentive payments have been an integral part of CenCal Health’s payment model since inception of the managed Medi-Cal program. Initially a risk sharing program, PCPs were paid via shared surpluses generated through appropriate utilization management. CenCal Health chose to adopt a methodology to compute financial incentives for utilization and quality management.

This model, in existence today, uses financial incentives based primarily upon a PCP’s utilization and quality performance relative to peers who share the same provider type and incorporates process measures more indicative of quality of care.

Overview

Some characteristics of this Incentive methodology are that it:

  • Includes timely incentive payments
  • Allows for monthly status reporting
  • Provides an adaptable framework to easily incorporate criteria
  • Improves case mix risk adjustment techniques
Funding for the program is obtained from the CenCal Health reserve funds and from the withhold contributed by all PCPs from the Guaranteed Payment.

Please view the PCP Incentive Program Protocols.


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