Quality Measures

Elevance Health Lawsuit Slams Medicare Advantage Star Ratings Calculation

January 9, 2024 - Elevance Health has filed a lawsuit against the Department of Health and Human Services (HHS), alleging its methodology for determining Medicare Advantage star ratings is unlawful. The payer and its affiliated entities filed the complaint against HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure in the United States District...


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Quality Outcomes Are Better When Medicaid MCOs Administer Pharmacy Benefits

by Victoria Bailey

Pharmacy-related quality outcomes were better in states where Medicaid managed care organizations administered health plans’ pharmacy benefits, according to a report from Elevance Health. The...

4 Key Strategies to Promote Effective Payer, Provider Alignment

by Victoria Bailey

Strong payer-provider alignment makes life easier for all healthcare stakeholders. While providers administer services to individuals, payers are responsible for reimbursing providers and ensuring members have coverage for their care....

How Quality Measures, Star Ratings Impact Healthcare Payers

by Editorial Staff

Quality performance metrics such as HEDIS, Medicare Advantage Star Ratings, and standardized core quality measures can give consumers an indication of healthcare payer quality. Standardized quality...

CQMC Revises Quality Measures, AHIP Advocates for Better Alignment

by Kelsey Waddill

Core Quality Measures Collaborative (CQMC) released new core quality measures and the implementation guidelines for certain core sets. More than 75 healthcare organizations, including payers,...

Common Utilization Measures That Impact Value-Based Care Efforts

by Kelsey Waddill

Quality and quantity have a nuanced relationship in the healthcare system: put simply, payers want to reduce members’ quantity of low-value services while increasing the number of services that produce better quality...

How Payers Can Identify Providers for High-Performing Networks

by Victoria Bailey

Enrolling in the right health plan can significantly influence healthcare costs and consumer health outcomes. Despite significant healthcare spending, the United States has the worst health outcomes among high-income countries. In 2021,...

Medicare Advantage Quality Bonus Program Needs Reform, Report Finds

by Victoria Bailey

The Medicare Advantage quality bonus program overpays plans and does not effectively promote quality care, indicating that program reforms are needed, according to an Urban Institute report. The...

How Plans Can Improve Race and Ethnicity Data Collection for HEDIS

by Kelsey Waddill

One question kept coming up when Keirsha Thompson, manager at National Committee for Quality Assurance (NCQA), and her team talked to payers: How can our health plan improve its performance on race and ethnicity data collection for the...

How Value-Based Purchasing Program Design Influences Outcomes

by Victoria Bailey

Payers should consider program design intensity when implementing value-based purchasing contracts, as higher-intensity programs can lead to better care quality and greater spending reductions, a...

Top 10 Highest Performing Medicare, Medicaid Health Plans

by Editorial Staff

The top-performing Medicare and Medicaid health plans for the 2020-21 plan year earned exceptional quality scores based on the plans’ customer satisfaction, preventive care, and treatment...

NCQA Shares Health Plan Performance Ratings Ahead of Open Enrollment

by Victoria Bailey

The National Committee for Quality Assurance (NCQA) has released its 2022 Health Plan Ratings, revealing that most plans earned three stars or higher for overall health plan performance. Each year,...

CMS Proposes Reporting Requirement for Medicaid, CHIP Quality Measures

by Victoria Bailey

CMS has released a proposed rule that aims to establish reporting requirements and standardize quality measures across Medicaid and the Children’s Health Insurance Program (CHIP) to help identify...

NCQA Adds New HEDIS Quality Measures to Improve Race, Gender Health Equity

by Kelsey Waddill

The National Committee for Quality Assurance (NCQA) announced changes to its quality measures for the 2023 Healthcare Effectiveness Data and Information Set (HEDIS), including race and ethnicity data...

Key Steps to Improve Coverage Integration for Dually Eligible Individuals

by Kelsey Waddill

In its June 2022 report to Congress, MACPAC laid out ways that states can improve the integration of Medicare and Medicaid coverage for dually eligible individuals. “Fully integrated models are...

Key Preventive Care Services Recommendations from USPSTF in 2022

by Kelsey Waddill

In the first half of 2022, the US Preventive Services Task Force (USPSTF) has issued several recommendations intended to promote effective preventive care services. The USPSTF recommendations may more...

NQF Opens Comment Period on Federal Program Quality Measures

by Kelsey Waddill

The National Quality Forum (NQF) has launched a comment period related to quality measures in federal programs. “Conducting a thoughtful review of performance measures used in federal programs...

AHIP Responds to Proposed CDC Opioid Prescribing Guidelines

by Kelsey Waddill

AHIP has responded to the latest updates to opioid prescribing guidelines from the Centers for Disease Control and Prevention (CDC). CDC’s proposed updates to the opioid prescribing guidelines...

CQMC Finds Quality Measurement Gaps, Supports Digital Measures

by Kelsey Waddill

Members of the Core Quality Measures Collaborative (CQMC), including AHIP, have identified multiple quality measurement gaps and recommended new digital quality measures and health equity quality...

Value-Based Care Models That Could Lower Maternal Care Costs

by Kelsey Waddill

Maternal healthcare costs in the US are too expensive, but value-based care may provide a solution, according to a brief from AHIP. “Americans need and deserve safe, high-quality, equitable and...