Value-Based Incentive Programs

Thank you for caring for our members by utilizing Sunshine Health programs and resources to help members live healthy lives.

We know that proactively engaging our members for needed health services can take administrative time and effort. The programs listed below are designed to support you in these proactive efforts.

These programs will reward you for engaging our members in needed care, like timely follow-up care after an inpatient behavioral health admission or for following evidenced-based guidelines for monitoring children and adolescents who are taking antipsychotic medications.

You will also receive financial incentives for your participation to help ensure healthy outcomes for mothers and newborns. We are continuing our Birth Outcomes Provider Incentive Program. The program’s incentive is tied to Notification of Pregnancy (NOP) forms. The incentive is paid monthly.

As valued health providers, you are automatically enrolled in these incentive programs. Sunshine Health will calculate the payments based on claims when care is provided. See details below.

Incentive programs
Type	Description	Incentive
Maternity: Notice of Pregnancy	Maternity providers are incentivized to improve birth outcomes by submitting a Notice of Pregnancy (NOP). This enables us to provide the best care and support to expectant mothers leading to healthy pregnancies and deliveries	$50 for each NOP form submitted through the Secure Provider Portal. Enter TIN in field labeled "OB Provider's ID #.”
Behavioral Health: Metabolic Monitoring of Antipsychotics	Behavioral health (BH) providers are incentivized to proactively engage members to provide metabolic monitoring for children and adolescents on antipsychotics.	$200 for ensuring blood glucose and cholesterol tests are done.
Behavioral Health: 7-Day Follow-Up	Behavioral health (BH) providers are incentivized to proactively engage members to ensure a follow up visit takes place after an inpatient admission.	$100 for follow-up visit after a discharge from a hospitalization for mental health or an intentional self-harm diagnosis.