Introducing the Enhanced Provider Pay-for-Performance Program
At Gateway Health, we value the important role practitioners play in serving our members. We support recognizing and rewarding performance for those practices committed to providing quality healthcare that is accessible and efficient. Therefore, working collaboratively with an advisory work group of network primary care practitioners, (MD, DO, NP and DDS) Gateway would like to welcome you to the enhanced Gateway to Practitioner Excellence® Program. This program supports Gateway’s mission to improve the health and wellness of the individuals and the communities we serve by providing access to integrated, superior health care.
- Developed in 2007 to recognize and reward physicians who were committed to providing quality healthcare that was accessible and efficient among Pennsylvania Managed Care Organizations.
- In 2012, DPW standardized program measures, and Gateway expanded the program to include obstetrical and dental care providers.
- In 2014 expanded to Medicare Assured and included new quantitative measures.
- In 2015 enhanced with rate based incentives acceptance of CPT II codes and FQHC modifications.
- In 2019 enhanced with a tiered payment structure and no minimum membership levels required for participation.
2019 Medicaid Program:
- Primary Care Practitioners (Family Practice, General Practice, Internal Medicine, Pediatricians and Credentialed CRNP PCPs)
- Obstetrical Care Providers
- Dentists
2019 Medicare Program:
- Primary Care Practitioners: Family Practice, General Practice, Internal Medicine, Geriatric Medicine, Clinical Nurse Specialist, Nurse Practitioner and Physician Assistants
- Specialists: Cardiology (Cardiovascular Disease, Adolescent, Advanced Heart Failure), Certified Nurse-Midwife, Certified Registered Nurse Practitioner (CRNP), Developmental Pediatrics, Adolescent Medicine, OB-GYN, Endocrinology (Metabolism), Oncology (Gynecologic, Hematology, Medical), Pediatrics (Cardiology, Endocrinology, Metabolism), Physician Assistant
If you have any questions about the Gateway to Practitioner Excellence® pay-for-performance program, please contact your Gateway Health Clinical Transformation Consultant and or your Provider Account Liaison.