The 2025 Pay for Performance Program
The YouthCare Pay for Performance (P4P) Program rewards its contracted partners in care for delivering quality preventive healthcare services such as children’s and adolescent’s immunizations, well-child visits, and weight assessments.
We listened to your opinions and have added an additional, lower target (the 50th percentile) for 2025. Our YouthCare P4P incentives for Primary Care Providers (PCPs) now includes a third target to reward incremental advancement.
Please contact your YouthCare Quality Practice Advisor, Associate Quality Practice Advisor, your Provider Relations Representative at ILProviderRelations@mhplan.com, or Provider Services at 844-289-2264 with questions.
The quickest way to access updated program information is via the secure provider portal. There you can view updated performance data, target percentile status, and payments earned year to date.
Primary Care Provider (PCP) Incentives* | |||||||
|---|---|---|---|---|---|---|---|
Measure Abbreviation | Measure Name | Target 1 (50th Percentile) | Payment 1 | Target 2 (75th Percentile) | Payment 2 | Target 3 (90th Percentile) | Payment 3 |
CIS – Combo 10 | Childhood Immunization Status – Combination 10 | 28% | $15.00 | 35% | $30.00 | 43% | $50.00 |
CIS – Flu | Childhood Immunization Status – Influenza | 37% | $5.00 | 45% | $10.00 | 55% | $20.00 |
IMA – HPV | Immunizations for Adolescents – (2-3 HPV dose series) | 36% | $7.50 | 43% | $15.00 | 51% | $30.00 |
WCC – BMI | Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents – BMI Percentile | 83% | $5.00 | 88% | $10.00 | 92% | $20.00 |
WCC – Nutrition | Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents – Nutrition Counseling | 72% | $5.00 | 80% | $10.00 | 85% | $20.00 |
WCC – Physical Activity | Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents – Physical Activity | 69% | $5.00 | 78% | $10.00 | 83% | $20.00 |
WCV | Child and Adolescent Well-Care Visits | 52% | $5.00 | 59% | $10.00 | 65% | $20.00 |
Rendering Provider Incentives** Provider may be PCP, Behavioral Health, or another qualified provider | |||||||
IET – Engagement | Engagement of substance use: Treatment —2 services within 34 days of initiating treatment | $50, no target needed | |||||
FUH – 7 | Follow-up after hospitalization for mental illness—7-day total | $50, no target needed | |||||
Incentives are paid after completion of all qualifying services in compliance with HEDIS® 2025 guidelines. A complete list of covered codes for these measures can be found within the HEDIS Quick Reference Guide 2024 on the YouthCare website.
*Incentives are paid to the Primary Care Provider at the provider TIN level. Payments will be made for Q1/Q2 2025, Q3 2025, and final 2025 performance throughout 2025 and 2026.
**Incentives are paid after Measurement Year 2025 is complete with an additional $50 per numerator compliant member paid to the rendering provider TIN. Payment will be made in late 2026.
YouthCare maintains the right to modify or discontinue the P4P program and will notify providers of changes or program alterations.