Provider Incentives

Primary Care Provider (PCP) incentive payments have been an integral part of CenCal Health’s payment model since inception of the managed Medi-Cal program.  CenCal Health has five PCP incentive programs to assist providers in managing their patients.  Below you will find information about each program.

Click here for an FAQ regarding CenCal Health's incentive programs, or learn more via the PCP Incentive Training video.
For more information about the CenCal Health's incentive programs you can contact Provider Services at (805) 562-1676.

 

PCP Incentive 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.

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 Full Capitation.

Please view the PCP Incentive Program Protocols.