The purpose of this project is to determine how managed care organizations (MCO’s) define, measure and report on “Quality” to the public, their enrollees and participating providers.
Logistics: Students will be expected to write a full explanation of each section. This assignment is worth 50 points. Roughly 10 points per section and another 10 points for overall impression.
1. Source: National Committee on Quality Assurance web site (www.ncqa.org).
How does NCQA define quality?
Look under “Performance Measures” and choose 5 HEDIS measures and provide a full explanation of each
What is CAHPS
What is PCMH
2 .Regarding the Health Plan Report Card -also NCQA.org
Within the NCQA website, locate the “Newsroom” Tab and select “The State of Health Care Quality Report”; then “Health Plan Report Card”. Select “Indiana” and “commercial insurance”. This will take you to a listing of plans in Indiana. Select two health plan from those listed that you wish to evaluate and compare
For each plan chosen; what are the 5 categories that are rated by stars for each plan and what star rating did these plans achieve for each category? What is the plan’s overall accreditation?
Define what each star-rated category means.
3. Source: https://qpp.cms.gov/
Compare MACRA versus MIPS
4. Summarize your findings
Is the NCQA “STAR” rating system an acceptable method for assessing/reporting quality from a consumer viewpoint?
Would the NCQA “star” rating make a difference to you when choosing a health plan?
What extra costs (premium) would you pay for a “higher quality” health plan?