2016 quality & patient safety annual report to the ... - palomar health

What are the QRS measures required for 2016?

The QRS measure set consists of measures that address areas of clinical quality management; enrollee experience; and plan efficiency, affordability, and management. Exhibit 1 includes the list of QRS measures required for 2016. The measure set includes a subset of NCQA’s HEDIS measures and one PQA measure.

What is the 2016 HEDIS for QRS version—NCQA?

2016 HEDIS for QRS Version—NCQA All Rights Reserved 77 Annual Dental Visit (ADV) Data Elements for Reporting Organizations that submit HEDIS for QRS data to NCQA must provide the following data elements. Table ADV-4: Data Elements for Annual Dental Visit Element Administrative Measurement year Data collection methodology (Administrative)

What was changed in the QRS 2016?

HEDIS QRS 2016 • Removed reference to “regional” in the “expected amount” definition; regional peer groups (regional versions of the O/E) were eliminated in the RRU calculations. • Removed references to “index ratio” and “index score” in the Relative Resource Use Results section; indexing of the O/E ratio was eliminated. Description

What are the NCQA guidelines for data collection for QHP measures?

For the PQA measure, QHP issuers should refer to NCQA’s “General Guidelines for Data Collection” (see Section 3.1 for guidance related to data collection protocols, with the exception of a few guidelines specific to the PQA measure as noted in Section 3.2). QRS survey measure technical specifications

What is CMS Quality Strategy?

The CMS Quality Strategy guides the activities of all agency components working together toward health care transformation.

What is the strategic result of care?

Strategic Result: Persons and families are engaged as informed, empowered partners in care.

What is the QRS measure set?

The QRS measure set is comprised of clinical quality measures, including the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Information and Data Set (HEDIS) measures and a Pharmacy Quality Alliance (PQA) measure. The measure set also includes survey measures based on questions from the Qualified Health Plan Enrollee Experience Survey (QHP Enrollee Survey).

What is QHP survey?

The QHP Enrollee Survey includes a core question set that will be used to assess enrollee experience with health care services. Specific questions are grouped to form survey measures that will be used in the QRS.

Does CMS use QHP ratings?

CMS will calculate the quality performance ratings for QHPs offered through all Marketplaces, regardless of the Marketplace model. CMS will apply the QRS rating methodology to validated QRS clinical measure data and a subset of the QHP Enrollee Survey response data (QRS survey measures) to produce quality ratings on a 5-star rating scale.

Does CMS collect quality ratings?

CMS will collect data and calculate quality ratings for each QHP issuer’s product type (e.g., health maintenance organization [HMO]) within each state and apply these ratings to each product type’s QHPs. Beginning with the 2017 Open Enrollment Period, Marketplaces are required to display QHP quality rating information on their websites prominently to help consumers compare QHPs.

Is NCQA responsible for any use of the measures?

NCQA is not responsible for any use of the measures.

What tests must Top Picks perform?

Safety: Top Picks must perform effectively in crash or rollover tests conducted by the government and insurance industry (if tested).

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