Thank you for being a Jefferson Health Plans participating provider and for your continued efforts to help manage the health of our members. We greatly appreciate the relationships we have built with our provider partners. We acknowledge that the work you do to continually improve the health outcomes of our shared members is not an easy task.

We have important information to share about our Quality Care Plus (QCP) program, including an overview of updates for the 2024 QCP program.

2024 QCP Program Updates

Jefferson Health Plans’ QCP program rewards your practice’s performance for delivering quality services to our members. Each year, we assess the program to ensure that it positively affects our members and providers. We typically add and remove measures, as well as adjust the benchmarks and payment amounts based on historical performance, network performance, NCQA benchmarks and CMS Stars benchmarks. This year, minimal changes were made to the program.

The changes outlined below will impact the 2024 measurement year (January 1 through December 31, 2024) and payments beginning in May 2025. Further clarification about how membership is calculated will be included in the QCP Manual.

Overall Program Changes

1. Eligibility Requirement: Effective for the 2024 measurement period, providers will continue to be required to see at least 25% of paneled Jefferson Health Plans Medicaid members during the 2024 measurement year in order to participate and earn any incentive dollars for Medicaid measures beginning with the May 2025 payment cycle. Only members enrolled for at least 10 months at the site during the measurement year and remaining enrolled as of December 31 of the measurement year will be included in the rate calculation. Telehealth visits are allowed and will count toward the visit rate. This requirement impacts the Medicaid line of business only and will not affect the Medicare or CHIP lines of business. We plan to increase this eligibility requirement to 30% for measurement year 2025.
2. Measure Denominator Minimum: To continue to promote statistical significance, Jefferson Health Plans will increase the minimum number of members in the individual measure’s denominator from 20 to 30 members for all lines of business. This means that your practice must have 30 members in the individual measure’s denominator to qualify and to receive any payment for that measure.
3. PCMH Bonus Removed: Jefferson Health Plans will no longer offer a quality bonus to PCMH participating practices in the QCP Program. Further detail will be shared with the PCMH participating practices.
4. HOS Bonus Removed: Jefferson Health Plans will remove the HOS bonus from QCP, but we will continue to share resources related to key HOS measures throughout 2024. Educational materials, including Jefferson Health Plans’ Provider Resource Guide:Improving Patient Experience – A Guidebook to CAHPS, HOS and Quality Resources, can be foundonline on our Quality and Population Health webpage available at HPPlans.com/Quality.
5. New Improvement Incentive Opportunity: Effective for the 2024 measurement period,Jefferson Health Plans will introduce a new improvement incentive in our QCP Program. Providers will be eligible to earn a $0.05 PMPM incentive payment if they improve their baseline rate by 5% for each of the below five measures:

• • Child and Adolescent Well-Care Visits (Total)
  • Controlling Blood Pressure
  • Developmental Screening in the First Three Years of Life
  • HbA1c Poor Control (>9.0%)
  • Lead Screening in Children

To be eligible for the improvement incentive, practices must have qualified for QCP during the previous measurement period (MY2023).

2024 Quality Measure Changes

1. Care of Older Adults: This Medicare measure was previously measured as a combo measure (Pain, Functional Status and Medication Review). In 2024, to continue to align with the CMS Medicare Stars Program more closely, Care of Older Adults – Pain Assessment and Care of Older Adults – Medication Review will be included as separate, stand-alone measures for Medicare only. Benchmarks for these measures will align with the most recently available Stars benchmarks released in October 2023.
2. Plan All-Cause Readmissions: This measure will continue to be included for both Medicare and Medicaid, but the measurement logic will differ by line of business. For Medicaid, we will continue to use the ratio of observed/expected readmissions (no changes). For Medicare, we will align with the CMS Medicare Stars Program measurement, which assesses the percentage of hospital stays during the measurement year that were followed by an unplanned readmission within 30 days.

Please see below for the complete list of the Medicare, Medicaid and CHIP measures included in the 2024 program.

For More Information

The updated 2024 QCP Manual is expected to be released at the end of the year and will include all appropriate information. The 2024 QCP manual will be available at HPPlans.com/QCP.

Your Network Market Manager will be working closely with you to ensure that your office understands these changes and to answer any questions. You can also contact our Provider Services Helpline at 1-888-991-9023, Monday to Friday, 9 a.m. to 5:30 p.m.

2024 QCP Program Measures

Here is the complete list of the Medicare, Medicaid and CHIP measures included in the 2024 program. The measurement period is January to December 2024 (to be reflected in payments beginning in May 2025).