Missouri Pay-for-Performance (P4P) Program

The primary goal of the Health and Wellness Program is to improve quality of care for MO HealthNet participants through better care coordination between the participant’s primary care physician (PCP) and other key providers, extensive outreach and education, continuous telephonic support for participants regarding their medical concerns, and a 24/7 nurse phone line.

MO HealthNet Division (MHD) also understands that improving the quality of care through the MH&W Program may be challenging for healthcare providers without additional resources. For this reason, MHD has elected to include provider “Pay for Performance” (P4P) payments as a key feature of this program.

There are two principal components to the Missouri Pay-for-Performance (P4P) Program:

• Outcomes Measurements – Measurements include select standard, peer-reviewed, best-practice clinical outcomes for each of the conditions for which participants are managed in the MH&W Program, including the use of inhaled corticosteroids for asthmatics, regular acquisition of glycosylated hemoglobin values and screening ophthalmology examinations for diabetics, the use of beta blockers and ACE inhibitors for participants with congestive heart failure, etc. 
   
• Pay-for-Participation – The participant’s primary care provider (PCP) receives incentive payments simply for participating in the Health and Wellness Program by reviewing a plan of care found online at the APS CareConnection® website.

These payments will be in addition to the PCP’s office visit fees. Pay-for-Participation is not contingent on participant outcomes. 

Click here to see the complete pay-for-performance program details or refer to the MO HealthNet Provider Bulletin Volume 31, Number 21, dated November 19, 2008.

MO HealthNet: Jefferson State Office Building, PO Box 6500, Jefferson City, MO 65102-6500
Phone: 1-866-464-7147 | Fax: 1-800-461-9184 | Email: mohealthandwellness@apshealthcare.com