Quality Reporting System. (QRS-Plan Service); related to Attachment 7, Section 3.01. Specific measures noted in Appendix 1 to this Attachment 14. Quality and Network Management – (QRS); related to Attachment 7, Section 3.01 Expectation: Plan Service- CAHPS measure set summary (Product type reporting) 106.255% of total performance requirement expected. Performance Level: <50th PCT:105% penalty;51-75th PCT: no penalty; >75th PCT: 105% performance credit (vs. national HMO benchmark). Covered California – Final Health Plan Contract Attachments, May 620117, 2013 Attachment 14-8 ATTACHMENTS TO COVERED CALIFORNIA QUALIFIED HEALTH PLAN CONTRACT 3.65 eValue8 – specific to Attachment 7, Section 3.05 Expectation: Total Covered California eValue8 performance, 795.5 points total. 10% of total performance penalty at risk. Performance Level: < 40% of total points: 10% performance penalty. 40-74% of total points-no penalty. 75% or greater of total points: 10% performance credit. Comment [A1]: This 3.6 is not on Xxxx’s edits so I have asked her to advise if it is intentionally deleted or needs to be put back in. Covered California – Final Health Plan Contract Attachments, May 620117, 2013 Attachment 14-9 ATTACHMENTS TO COVERED CALIFORNIA QUALIFIED HEALTH PLAN CONTRACT Covered California Performance Standards for Contractor Group 3 continued: Covered California Performance Standards Quality, Network Management and Delivery System Standards 0.0% of Performance Penalty or Credit for Measurement Year 2014 50% of Performance Penalty or Credit ThereafterQuality, Network Management and Delivery System Standards 50% of Performance Penalty or Credit
Quality Reporting System. (QRS) - Access to Care- HEDIS/CAHPS measure set summary Access to Care Getting Care Quickly Composite (CAHPS) Getting Needed Care Composite (CAHPS) Child and Adolescent Access to Primary Care Practitioners (12-14, 25mo-6yr, 7-11, 12-19) HEDIS Adults' Access to Preventive/Ambulatory Health Services (20 to 44 years and 45 to 64 years) HEDIS *certain CAHPS measures may not be available for all Product Types
Quality Reporting System. (QRS)-) - Plan Service- CAHPS measure set summaryQuality and Network Management – QRS Expectation: Plan Service - CAHPS measure set summary (Product type reporting) - 10% of total performance requirement expected. Plan Service Claims Processing Composite (CAHPS) Customer Service Composite (CAHPS) Plan Information on Costs Composite(CAHPS) Global Rating of Plan(CAHPS) *certain CAHPS measures may not be available for all Product Types
Quality Reporting System. (QRS-Plan Service); related to Attachment 7, Section 3.01. Specific measures noted in Appendix 1 to this Attachment 14. Quality and Network Management – (QRS); related to Attachment 7, Section 3.01 Expectation: Plan Service- CAHPS measure set summary (Product type reporting) 106.255% of total performance requirement expected. Performance Level: <50th PCT:105% penalty;51-75th PCT: no penalty; >75th PCT: 105% performance credit (vs. national HMO benchmark). 3.65 eValue8 – specific to Attachment 7, Section 3.05 Expectation: Total Covered California eValue8 performance, 795.5 points total. 10% of total performance penalty at risk. Performance Level: < 40% of total points: 10% performance penalty. 40-74% of total points-no penalty. 75% or greater of total points: 10% performance credit. Covered California Performance Standards for Contractor Group 3 continued: Covered California Performance Standards Quality, Network Management and Delivery System Standards 0.0% of Performance Penalty or Credit for Measurement Year 2014 50% of Performance Penalty or Credit ThereafterQuality, Network Management and Delivery System Standards 50% of Performance Penalty or Credit 3.75 6 Quality and Network Management- Health Status Assessment; Attachment 7, Section 3.06. Performance expectation to be determined in collaboration with QHPs based on 2014 measurement with Year 1- Track only; Year 2-3 performance measure based on Year 1 determined performance with preliminary target of exceeding QHP 50th percentile to avoid penalty NOTE: for 2014 measurement year/2015 penalty/credit assessment, track and report to QHPs only;5% penalty at risk thereafter (2015 measurement and beyond) 3.86 7 Quality and Network Management- Preventive Health and Wellness; Attachment 7, Section 4.01. Performance expectation to be determined in collaboration with QHPs based on 2014 measurement with preliminary target of exceeding QHP 50th percentile to avoid penalty NOTE: for 2014 measurement year/2015 penalty/credit assessment, track and report to QHPs only;5% penalty at risk thereafter (2015 measurement and beyond) Year 1- Track only; Year 2-3 performance measure based on Year 1 determined performance with preliminary target of exceeding QHP 50th percentile to avoid penalty 3.97 8 Quality and Network Management- New Care Models; Attachment 7, Section 5.02. Performance expectation to be determined in collaboration with QHPs based on 2014 measurement with preliminary target of exceeding QHP 50th percentile t...
