Pay for Performance

Enhancing Revenue

Pay for performance (P4P) rewards members with a portion of the financial savings produced by TXCIN physicians. Each payor’s P4P program is unique with a combination of Quality and Efficiency performance measures. TXCIN offers more P4P programs than any other IPA in the marketplace, through the following contracts:

  • BlueCross BlueShield of Texas – commercial, all physicians eligible
  • Aetna Commercial – all physicians eligible
  • Aetna Medicare Advantage – PCPs only

Participating in Pay for Performance

If you are opted into any of the participating plans, you are automatically enrolled in their pay for performance program. To get a financial performance reward, you must improve:

  • Quality Measures
  • Efficiency Measures
  • Steerage Measures

Which plans offer Pay for Performance?

  • BlueCross BlueShield of Texas – commercial, all physicians eligible
  • Aetna commercial – all physicians eligible
  • Aetna Medicare Advantage – PCPs only
  • Humana Medicare Advantage – PCPs only
  • HealthSpring Medicare Advantage – PCPs only
  • Wellcare Medicare Advantage – PCPs only
  • Universal Medicare Advantage – PCPs only

What is Pay for Performance?

A program that offers incentive payments to physicians for following specific quality and efficiency measures.

How do I participate in P4P?

Simply opting into the health plan puts you in the P4P program for that plan. You must incorporate the quality and efficiency measures into your patient care and code those properly to be rewarded. Specialists are eligible for the commercial P4P contracts only.

How will I get paid?

TXCIN receives the check from the health plan and distributes to the physicians that meet the requirements. You can receive your P4P rewards payments through direct deposit — ask your Account Manager or the TXCIN Support Desk (xxx-xxx-xxxx) for more information.

How is that money calculated?

Incentive payment calculations are written into each contract. TXCIN splits the actual dollars by a percentage across the physician population who met the target.

What is the average size of the P4P check?

Check sizes vary. They can range from $100 to over $10,000.

What are quality scores based on?

Star Quality Indicators and HEDIS Measures established by Medicare.

How can I increase the size of my P4P check?

Make an appointment with your Account Manager to review the P4P measures that apply to you. We can review the P4P measures to assist you in increasing your P4P dollars.

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