MOC 4 Scoring Guidelines

MOC 4: MOC Quality Measurement and Performance Improvement

The goal of performance improvement and quality measurement is to improve the SNP’s ability to deliver high-quality health care services and benefits to its SNP beneficiaries. Achievement of this goal may be the result of increased organizational effectiveness and efficiency through incorporation of quality measurement and performance improvement concepts that drive organizational change.

The leadership, managers and governing body of a SNP organization must have a comprehensive quality improvement program in place to measure its current level of performance and determine if organizational systems and processes must be modified, based on performance results.

Element A: MOC Quality Performance Improvement Plan

The organization must develop a MOC quality performance improvement plan that:

  1. Describes the overall quality improvement plan and how the organization delivers or provides for appropriate services to SNP beneficiaries, based on their unique needs.
  2. Describes specific data sources and performance and outcome measures used to continuously analyze, evaluate and report MOC quality performance.
  3. Describes how its leadership, management groups, other SNP personnel and stakeholders are involved with the internal quality performance process.
  4. Describes how SNP-specific measurable goals and health outcomes objectives are integrated in the overall performance improvement plan, as described in MOC 4, Element B.

Scoring

100%: The organization meets all 4 factors
80%: The organization meets 3 factors
50%: The organization meets 2 factors
20%: The organization meets 1 factors
0%: The organization meets no factors

Explanation

Definition

Quality measurement and performance improvement: A collaborative process for improving an organization’s ability to deliver high-quality health care services and benefits to SNP beneficiaries.

Factors 1–4

The organization’s MOC must describe how the quality performance improvement plan specific to the MOC, is designed to detect whether the overall MOC structure effectively accommodates beneficiaries’ unique health care needs.

The MOC must describe the SNP’s process for continuous collection, analysis, evaluation and reporting on quality performance based on the MOC. The MOC should describe the frequency of these activities.

The MOC must provide details about how the key personnel listed in factor 3 are involved in internal quality performance processes. It should provide information about which personnel are involved, their role in analyzing quality performance information and the decision-making authority given to such personnel.

The organization must specify data used for analyses, and must identify clear measures to determine if stated goals or outcomes are achieved. Measures must have a benchmark or goal, specify time frames for achieving outcomes and state a plan for remeasurement if the goal is not achieved.

Element B: Measureable Goals and Health Outcomes for the MOC

The organization must identify and clearly define measurable goals and health outcomes for the MOC and:

  1. Identify and define the measurable goals and health outcomes used to improve the health care needs of SNP beneficiaries.
  2. Identify specific beneficiary health outcome measures used to measure overall SNP population health outcomes at the plan level.
  3. Describe how the SNP establishes methods to assess and track the MOC’s impact on SNP beneficiaries’ health outcomes.
  4. Describe the processes and procedures the SNP will use to determine if health outcome goals are met.
  5. Describe the steps the SNP will take if goals are not met in the expected time frame.

Scoring

100%: The organization meets all 5 factors
80%: The organization meets 4 factors
50%: The organization meets 2-3 factors
20%: The organization meets 1 factors
0%: The organization meets no factors

Explanation

Factor 1: Identify goals

A description of measurable goals must include benchmarks, specific time frames and how achieving goals will be determined.

Responses should include, but not be limited to:

  1. Specific goals for improving access and affordability of the healthcare needs outlined for the SNP population described in MOC 1.
  2. Improvements made in coordination of care and appropriate delivery of services through the direct alignment of the HRAT, ICP and ICT.
  3. Enhanced care transitions across all health care settings and providers for SNP beneficiaries.
  4. Ensuring appropriate utilization of services for preventive health and chronic conditions.

Factor 2: Identify health outcome measures

For the stated health outcome measures, the organization must include the specific data sources it will use for measurement. The MOC should describe the specific measures the organization will use to meet the overall quality goals detailed in factor 1, including expected timeframes for meeting those goals.

Factors 3 & 4: Track and assess goals

The MOC must describe the methods the organization uses to assess and track how its overall quality program, including the goals and specific measures it uses, affect the health outcomes of its beneficiaries. This may include the data collected, how it is collected and analyzed and how often it is collected and analyzed.

For factor 4, the MOC must describe how it determines if the goals described in factor 1 are met.

Factor 5: Steps if goals not met

The organization must describe the actions it will take if it determines that goals are not met within the specified timeframes.

Element C: Measuring Patient Experience of Care (SNP Member Satisfaction)

The organization’s MOC must address the process of measuring SNP member satisfaction by:

  1. Describing the specific SNP survey used.
  2. Explaining the rationale for the selection of a specific tool.
  3. Describing how results of patient experience surveys are integrated into the overall MOC performance improvement plan.
  4. Describing steps taken by the SNP to address issues identified in survey responses.

Scoring

100%: The organization meets all 4 factors
80%: The organization meets 3 factors
50%: The organization meets 2 factors
20%: The organization meets 1 factors
0%: The organization meets no factors

Explanation

Factors 1–4

The MOC must describe the types of surveys used to assess SNP member experience, the rationale for the use of a specific tool and how results are integrated into the overall performance improvement plan.

Member feedback can include information about the overall SNP program or program staff (e.g., ICT or case managers), the usefulness of the information disseminated by the organization and the member’s ability to adhere to recommendations.

Methodology. The organization must describe how it receives feedback from a broad sample of members, not only those who contact the organization to share feedback. Member feedback may be obtained by conducting focus groups or through member experience surveys. The organization must describe how it analyzes feedback to identify and address issues. Feedback must be specific to the experience with the SNP overall programs being evaluated.

The organization must be able to describe the methodology it uses to collect patient experience surveys, including the sample size used.

Element D: Ongoing Performance Improvement Evaluation of the MOC

The organization’s MOC description must describe:

  1. How the organization will use the results of the quality performance indicators and measures to support ongoing improvement of the MOC.
  2. How the organization will use the results of the quality performance indicators and measures to continually assess and evaluate quality.
  3. The organization’s ability for timely improvement of mechanisms for interpreting and responding to lessons learned through the MOC performance evaluation.
  4. How the performance improvement evaluation of the MOC will be documented and shared with key stakeholders.

Scoring

100%: The organization meets all 4 factors
80%: The organization meets 3 factors
50%: The organization meets 2 factors
20%: The organization meets 1 factors
0%: The organization meets no factors

Explanation

Factors 1–4

The organization must provide a written description of the ongoing performance improvement evaluation of its MOC. This process must describe how the organization will use the results to assess and evaluate its quality performance indicators on a continual basis, including how the organization improves its ongoing performance by incorporating lessons learned. Lessons learned must be documented and communicated with key stakeholders.

Element E: Dissemination of SNP Quality Performance Related to the MOC

The organization must address the process for communicating its quality improvement performance by:

  1. Describing how performance results and other pertinent information are shared with multiple stakeholders.
  2. Stating the scheduled frequency of communications with stakeholders.
  3. Describing the methods for ad hoc communication with stakeholders.
  4. Identifying the individuals responsible for communicating performance updates in a timely manner.

Scoring

100%: The organization meets all 4 factors
80%: The organization meets 3 factors
50%: The organization meets 2 factors
20%: The organization meets 1 factors
0%: The organization meets no factors

Explanation

Factors 1–4

The organization describes how quality performance results are routinely shared with stakeholders, and specifies the frequency of these communications and how ad hoc and other unplanned communications are disseminated.

The organization’s plan to disseminate information must include individuals responsible for providing communication (as described in MOC 2, Element A). The MOC must describe methods for communication (regular and ad hoc) with stakeholders and time frame for communication with stakeholders, who may include, but are not limited to:

  • SNP leadership.
  • SNP management groups.
  • SNP boards of directors.
  • SNP personnel and staff.
  • SNP provider networks.
  • SNP beneficiaries and caregivers.
  • The general public.
  • Regulatory agencies.