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 deliver quality programs that positively impact the personal health and well-being of its members.
- 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.
2018 Medicaid Program:
- Primary Care Physician practices (Family Practice, Internal Medicine and Pediatrics) with a minimum panel size of 50 or more members. Medicaid only
- Obstetrical Care Providers (panel size not required) Medicaid only
- Dentists (panel size not required) Medicaid only
2018 Medicare Program:
- Primary Care Physician practices (Family Practice, Internal Medicine and Pediatrics) with a minimum panel size of 30 or more members. PA Medicare only
- Primary Care Physician practices (Family Practice, Internal Medicine and Pediatrics) panel size not required. KY, NC & OH Medicare only
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 Relations Representative.