Provider Quality Performance (PQP) Program
The Provider Quality Performance (PQP) Program is San Francisco Health Plan’s pay-for-performance incentive program for Medi-Cal clinics and medical groups to achieve improvements in system and health outcomes.
Primary Objectives
Aligned with the Quadruple Aim:
- Improving patient experience
- Improving population health
- Reducing the per capita cost of health care
- Improving staff satisfaction
Provide Financial Incentives to Reward Improvement in the Provider Network
Program Eligibility Requirements
- Clinics or medical groups that directly contract with SFHP (see below for current participants)
- Assigned primary care medical home for 300+ SFHP members and/or HSF participants
Guiding Principles
- Comprehensive measurement across multiple domains
- Collaborative measure and program development
- Standardized measurement across all provider groups
- Financial incentives to motivate improvement
- Technical assistance that supports ongoing improvements
Measure Domains
Clinical Quality
- Measures generally come from external sources, prioritizing HEDIS and NCQA metrics
- Factors taken into consideration are improvement potential, self- reporting feasibility, and how measure impacts SFHP (e.g. through auto-assignment)
Data Quality
- Measures support both DHCS electronic data requirements and comprehensiveness of coding
Patient Experience
- Measures based on lowest performing CAHPS composite (currently Access)
Systems Improvement
- Measures support collaboration between various systems within which patients access care
Governance
- Funding is determined by Executive Team and Governing Board every September.
- PQP Advisory Committee provides input on measurement sets and advises on feasibility and alignment with other institutions.
- SFHP Governing Board and SFHP Quality Improvement Committee receive high-level updates at least yearly.
Current Participants:
- Brown & Toland Physicians
- Chinese Community Health Care Association
- HealthRIGHT360
- Hill Physicians Medical Group
- Jade Health Care Medical Group
- Lyon-Martin Community Health Services
- Marin City Health & Wellness Center
- Mission Neighborhood Health Center
- Native American Health Center
- North East Medical Services
- San Francisco Community Health Center
- SFHN Primary Care
- South of Market Health Center
- St. Anthony Medical Clinic
- UCSF Clinical Practice Group
- UCSF Health