The Pay for Performance Program
The YouthCare Pay for Performance (P4P) Program rewards contracted partners in care for delivering quality preventive services such as children’s and adolescent’s immunizations, and well-child visits.
For 2026, there are three P4P incentive target levels for YouthCare Primary Care providers to reward incremental advancement.
Updates for 2026
- There are more Child and Adolescent Well-Care Visits (WCV) incentive categories to better represent childhood development
- Many healthcare services can be completed via telehealth. See measures noted with a star ★
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 YouthCare secure provider portal. After logging in, 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 |
|---|---|---|---|---|---|---|---|
★ ADD – Initiation | Follow-up care for Children Prescribed ADHD Medication – Initiation Phase | 47% | $5 | 51% | $10 | 58% | $20 |
★ ADD – Continuation & Maintenance | Follow-up care for Children Prescribed ADHD Medication – Continuation & Maintenance Phase | 56% | $10 | 61% | $20 | 66% | $40 |
CIS – Combo 10 | Childhood Immunization Status – Combination 10 | 24% | $15 | 29% | $30 | 35% | $60 |
CIS – Flu | Childhood Immunization Status – Influenza | 36% | $5 | 42% | $10 | 50% | $20 |
IMA – HPV | Immunizations for Adolescents – (2-3 HPV dose series) | 36% | $10 | 42% | $20 | 49% | $40 |
★ WCC – BMI | Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents – BMI Percentile | 85% | $5 | 90% | $10 | 92% | $20 |
★ WCC – Nutrition | Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents – Nutrition Counseling | 74% | $5 | 82% | $10 | 86% | $20 |
★ WCC – Physical Activity | Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents – Physical Activity | 70% | $5 | 79% | $10 | 84% | $20 |
WCV | Child and Adolescent Well-Care Visits – Ages 3 - 11 | 62% | $5 | 68% | $10 | 84% | $20 |
WCV | Child and Adolescent Well-Care Visits – Ages 12 - 17 | 55% | $5 | 62% | $10 | 67% | $20 |
WCV | Child and Adolescent Well-Care Visits – Ages 18 - 21 | 33% | $5 | 38% | $10 | 47% | $20 |
Rendering Provider Incentives**
Provider may be PCP, Behavioral Health, or another qualified provider
Measure Abbreviation | Measure Name | Payment/Target |
|---|---|---|
★ IET – Engagement | Engagement of substance use: Treatment —2 services within 34 days of initiating treatment | $100 per compliant visits, no target to meet |
★ FUH – 7 | Follow-up after hospitalization for mental illness—7-day total | $50 per compliant visit, no target to meet |
Incentives are paid after completion of qualifying services in compliance with 2026 HEDIS® guidelines. A complete list of covered codes is in the HEDIS Quick Reference Guide on the YouthCare website.
★ Indicates a measure can be completed via a telehealth visit
*Incentives are paid to the Primary Care Provider (PCP) at the provider TIN level. Payments will be made for Q1/Q2 2026, Q3 2026, and final 2026 performance throughout 2026 and 2027.
** Incentives are paid to the provider who rendered the service at the provider TIN level. Claims must be submitted by 12/31/2026. Payment will be made in Q1 2027.
YouthCare maintains the right to modify or discontinue the P4P program and will notify providers of changes or program alterations.