The Affordable Care Act (ACA) requires the Centers for Medicare and Medicaid Services (CMS) issue employer group health plan quality improvement reporting requirements. Reports shall cover specified quality improvement activities regarding plan or coverage benefit and provider reimbursement structures. Those requirements shall include efforts to improve health outcomes, ensure patient safety and reduce medical errors, prevent hospital readmissions, and implement wellness and health promotional activities.
In Health Plan Quality Improvement Strategy Reporting Under the Affordable Care Act: Implementation Considerations, the Commonwealth Fund summarizes features of the eValue8 Health Plan Request for Information (RFI), Medicaid external review process, and National Committee for Quality Assurance (NCQA) accreditation. The HHS National Quality Strategy is offered as a framework for reporting requirements.
The report discusses approaches for measuring health plan efforts to improve quality. Performance measure reporting is required by the Center for Medicare and Medicaid Services for those health plans participating in Medicare Advantage. Several measures are also required by states.
The unique needs of various audiences who use reported health plan quality information should be considered during reporting requirement design and implementation. Audiences include state oversight and health information exchange boards, health plans, employers, consumers, hospitals, physicians, and provider organizations.
Key considerations were discussed at a roundtable meeting encompassing AcademyHealth, government officials, experts, and stakeholders. From this, seven recommendations are offered in the report for implementing reporting requirements under the Affordable Care Act.
To read or download the full report, click here (PDF).