2025 Provider Quality Incentive Program

Program Overview

MVP Health Care® (MVP) is excited to announce its 2025 Quality Incentive Program, offering eligible Participating Providers the opportunity to earn incentives by delivering high quality health care to MVP Members during calendar year 2025, and submitting appropriate coding.  

2025 Measures and Targets

Medicaid

Measure/Link to MVP tip sheet	Measure Description	2.5% Rate Improvement Target	5% Rate Improvement Target	7.5% Rate Improvement Target
		Payment per improvement gap closed	Payment per improvement gap closed	Payment per improvement gap closed
APM-E	Metabolic Monitoring for Children and Adolescents on Antipsychotics	$125	$175	$175
BCS-E	Breast Cancer Screening	$125	$175	$175
CBP	Controlling Blood Pressure	$125	$175	$175
CCS	Cervical Cancer Screening	$125	$175	$175
CHL	Chlamydia Screening	$125	$175	$175
COL-E	Colorectal Cancer Screening	$125	$175	$175
DEV	Developmental Screening in the First Three Years of Life	$125	$175	$175
DSF	Depression Screening and follow Up	$50	$50	$50
EED	Diabetes Care – Eye Exam	$125	$175	$175
GSD	Glycemic Status Diabetes	$125	$175	$175
IMA	Immunizations for Adolescents	$125	$175	$175
KED	Diabetic: Kidney Health Evaluation	$125	$175	$175
W30	Well-Child Visits in the First 30 Months of Life	$125	$175	$175

Essential Plan

Measure/Link to MVP tip sheet	Measure Description	2.5% Rate Improvement Target	5% Rate Improvement Target	7.5% Rate Improvement Target
		Payment per improvement gap closed	Payment per improvement gap closed	Payment per improvement gap closed
AIS	Adult Immunization Status- Influenza	$50	$50	$50
BCS-E	Breast Cancer Screening	$125	$175	$300
CBP	Controlling Blood Pressure	$200	$250	$375
CCS	Cervical Cancer Screening	$125	$175	$300
CHL	Chlamydia Screening	$125	$175	$300
COL-E	Colorectal Cancer Screening	$125	$175	$300
DSF	Depression Screening and follow Up	$50	$50	$50
EED	Diabetes Care – Eye Exam	$125	$175	$300
GSD	Glycemic Status Diabetes	$200	$250	$375
KED	Diabetic: Kidney Health Evaluation	$125	$175	$300
SNS-E	Social Need Screening and Intervention	$50	$50	$50

HARP

Measure/Link to MVP tip sheet	Measure Description	2.5% Rate Improvement Target	5% Rate Improvement Target	7.5% Rate Improvement Target
		Payment per improvement gap closed	Payment per improvement gap closed	Payment per improvement gap closed
AIS	Adult Immunization Status Influenza	$50	$125	$125
BCS-E	Breast Cancer Screening	$50	$125	$125
CBP	Controlling Blood Pressure	$50	$125	$125
CCS	Cervical Cancer Screening	$50	$125	$125
EED	Diabetes Care – Eye Exam	$50	$125	$125
GSD	Glycemic Status Diabetes	$50	$125	$125
SPC	Statin Therapy for Patients with CVD	$50	$125	$125

Medicare

Measure/Link to MVP tip sheet	Measure Description	2.5% Rate Improvement Target	5% Rate Improvement Target	7.5% Rate Improvement Target
		Payment per improvement gap closed	Payment per improvement gap closed	Payment per improvement gap closed
BCS-E	Breast Cancer Screening	$100	$200	$500
CBP	Controlling Blood Pressure	$100	$200	$500
COL-E	Colorectal Cancer Screening	$100	$200	$500
EED	Diabetes Care – Eye Exam	$100	$200	$500
GSD	Glycemic Status Diabetes	$100	$200	$500
KED	Diabetic: Kidney Health Evaluation	$100	$200	$500
MAC	Medication Adherence: Cholesterol	$100	$200	$500
MAD	Medication Adherence: Diabetes	$100	$200	$500
MAH	Medication Adherence: Hypertension	$100	$200	$500
SPC	Statin Therapy for Patients with Cardiovascular Disease	$100	$200	$500
SUPD	Statins Use with Diabetes	$100	$200	$500
Medicare Priority Member Bonus: An additional $100 bonus is available for each MVP identified priority member gap closed, once improvement target is reached

Provider Eligibility Requirements

Providers currently contracted in an existing value-based arrangement or quality incentive contract with MVP are ineligible for the QIP for those measures by LOB where currently contracted for. 

A minimum denominator size of 30 for per incentivized measure is required to be eligible for incentive payment. To confirm eligibility for the 2025 Quality Incentive Program please talk to your Provider Network Representative.

Program Requirements

To qualify for payments, 2025 (administrative) year-end performance per incentive eligible measure must be at least 2.5% above 2024-year end rate. Payment is based on each incremental improvement gap closed above the target rate; not all care gaps closed.

Once the rate improvement target is achieved, MVP will pay per improvement gap closed in 2025, above 2024-year end rate
Year-end Performance below the improvement rate targets receive $0 payout for that measure
Upon completion of care, providers must submit the claim or supplemental data file containing all required codes to achieve performance improvement and receive payment.

Measurement Period and Payment

Incentive payments will be made one time by the end of Q2 2026.

Payment is based on each eligible (attributed) patient who receives services, or claims we receive for services rendered for dates of service between January 1, 2025, and December 31, 2025. MVP must receive all claims by March 31, 2026. 

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