managed health care 2

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 (

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

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:

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?

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