HSA 532 Managed Care Quality Assessment Paper
Science
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.
Directions:
1. Source: National Committee on Quality Assurance web site (www.ncqa.org).
How does NCQA define quality?
Define HEDIS
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?
