Overview of 2007 Quality Assurance Activities Maryland Department of Health and Mental Hygiene November 29, 2007 Overview 2007 Quality review activities: Systems Performance Review Healthy Kids Quality Monitoring Program Enrollee Satisfaction Survey
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Maryland Department of
Health and Mental Hygiene
November 29, 2007
System Performance Review (continued)
Enrollee Satisfaction Surveys (continued)
Access/Availability of Care
Effectiveness of Care
Use Of Services
HEDIS Performance Measures (continued)
AGM = AMERIGROUP Maryland, Inc. NMH = National Medicaid HEDIS Mean
HFC = Helix Family Choice, Inc. MARR = Maryland Average Reportable Rate DIA = Diamond Plan - the Medicaid product line of Coventry Health Care MMA = Maryland MCO Average
JMS = Jai Medical Systems Managed Care Organization, Inc
MPC = Maryland Physicians Care
PP = Priority Partners
UHC = UnitedHealthcare of the Mid-Atlantic, Inc. Report Indicators: NR = Not Reportable NA = Not Applicable
Value-Based Purchasing (continued)
For any measure that the MCO does not meet the minimum target, a disincentive of 1/9 of 1/2 percent of the total capitation paid to the MCO during the measurement year will be collected.
For any measure that the MCO exceeds the minimum target, the MCO shall be paid an incentive payment of up to 1/9 of 1/2 percent of the total capitation amount paid to the MCO during the measurement year.
Improving the Delivery of Prenatal/Postpartum Care was completed in 2007.
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Select “Medical Care Programs”, “HealthChoice Managed Care”, “HealthChoice Quality Assurance Activities”