PCP Incentive Dashboard

Your Incentive Program

CY2026 · 195 eligible members · $20 PMPM

Cohort 1 — Target Based

Annual Maximum

195 members × $20 × 12 months

Quarterly Max

$11,700

50% Quality · 50% AWV/HCC

2024 Actual (Prior Year)

of $7,100 potential · $8.33 eff. PMPM

2026 opportunity vs. 2024 earnings17× potential increase

2024: $2,7002026 max: $46,800

Close 21 quality gaps across all measures to reach the next incentive tier on every measure

3.81Star Rating

+0.74 from 3.07

Target: 4.0

Emblem4.20

Aetna3.81

Priority Measures

CY2026 · Medicare Advantage · Quarterly targets

CBPNear Target

Controlling Blood Pressure

79%

+3% from 76%

51 of 65 compliant

14 open gaps · 31th percentile

Tier 2 (85%)Tier 1 (90%)

Close 5 more gaps to reach 85% (Tier 2 / 4-Star)

GSDNear Target

Glycemic Status in Diabetes

82%

+1% from 81%

37 of 45 compliant

8 open gaps · 24th percentile

Tier 2 (85%)Tier 1 (90%)

Close 2 more gaps to reach 85% (Tier 2 / 4-Star)

KEDBelow Target

Kidney Health Evaluation

58%

+8% from 50%

26 of 45 compliant

19 open gaps · 18th percentile

Tier 2 (80%)Tier 1 (90%)

Close 10 more gaps to reach 80% (Tier 2 / 4-Star)

ADHOn Track

Medication Adherence (Combined)

90%

+2% from 88%

74 of 82 compliant

8 open gaps · 72th percentile

Tier 2 (90%)Tier 1 (95%)

Tier 2 achieved! Close 4 more gaps to reach 95% (Tier 1 / 5-Star)

Quick Wins

Patients closest to compliance — minimal effort to close

CBP

Russo, AnthonyAetna · AET-7724183

BP 142/88 — borderline, one reading can close

CBP

O'Brien, MargaretEmblem · EMB-5519284

Needs CPT II codes — chart may close gap

CBP

Baptiste, LucilleAetna · AET-6638201

Needs CPT II codes — chart may close gap

CBP

Cruz, JosephineAetna · AET-9915432

BP 140/91 — borderline, one reading can close

GSD

Katz, ArthurEmblem · EMB-7782134

Needs CPT II codes — chart may close gap

GSD

Delvecchio, FrancesAetna · AET-5561298

Needs CPT II codes — chart may close gap

Medication Alerts

Overdue refills impacting adherence

Jenkins, Harold47d overdue

Metformin 850mg · CVS Pharmacy

(718) 876-5500

Petrov, Robert34d overdue

Losartan 50mg · CVS Pharmacy

(718) 876-5500

Steinberg, Howard33d overdue

Lisinopril 10mg · Rite Aid

(718) 448-2900

Jenkins, Harold24d overdue

Atorvastatin 40mg · CVS Pharmacy

(718) 876-5500

Gonzalez, Maria19d overdue

Metformin 500mg · MedRite Pharmacy

(718) 525-8989

Pillar 2 — AWV & Risk Adjustment

50% of PMPM

HCC documentation · AWV completion · RAF accuracy

AWV Completion

Annual Wellness Visits

68%

133 of 195 completed

Target: 85%

62 AWVs remaining

Target: 85%

HCC Recapture

Risk adjustment documentation

High Confidence (>85%)

20 members · 24 HCCs

$43,265

Medium Confidence (67.5–85%)

26 members · 28 HCCs

$36,281

Total RAF Opportunity$79,546

Top HCC Targets

10 members

Russo, Anthony

HCC 85 · Congestive Heart Failure

Health Plan Audit

Washington, Gloria

HCC 18 · Diabetes with Chronic Complications

HCC Targeting

Gonzalez, Maria

HCC 22 · Morbid Obesity

HCC Targeting

Thompson, William

HCC 85 · Heart Failure, Unspecified

AWV Needed

Steinberg, Howard

HCC 18 · Diabetes with Ophthalmic Manifestations

Health Plan Audit

Schwartz, Leonard

HCC 18 · Type 2 Diabetes

HCC Targeting

Papadopoulos, Helen

HCC 59 · Major Depressive Disorder, Recurrent

AWV Needed

Cruz, Josephine

HCC 108 · Vascular Disease

Health Plan Audit

Utilization Overview

Performance vs. network benchmarks

Measure	Performance	Network Benchmark	Opportunity / Comments
Utilization & Cost Trend (PMPM)	$812	$745	Higher than peers — review high-cost drivers
Readmission Rate (30-day)	14.2%	>7%	Avoidable CHF/COPD admissions noted
ADK (Acute Admission per 1,000)	102	88	Elevated — care management referral opportunities
EDK (ED Visits per 1,000)	312	260	High non-emergent ED utilization
TRC Engagement (Post-Discharge)	63%	78%	Outreach gaps within 48 hours of discharge
Brand-to-Generic Conversion	76%	85%	Candidates: rosuvastatin, duloxetine, sitagliptin
Site-of-Service Optimization	21%	34%	Shift infusions & imaging to ambulatory centers

2026 Medicare PCP Provider Incentive Program

224 total MA members · 195 Emblem + Aetna · Quarterly payouts · Richmond County

Rep

Kalilou Kane

NPI

1033284906

Practice

Nicolette E. Filitis, MD