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MassHealth Quality Reports and Resources

On this web page you will find quality resources including HEDIS, Managed Care Quality Strategy, MassHealth Member Experience, MassHealth Managed Care (MCE) Accreditation Information and additional resources.

Table of Contents

Quality Strategy

The Executive Office of Health and Human Services updated its comprehensive quality strategy that reflects MassHealth’s quality goals and objectives, quality management framework, and agency-wide quality activities. The quality strategy incorporates CMS guidance utilizing the updated Quality Strategy Toolkit and maintains adherence to the regulatory managed care rule requirements. It includes a description of agency-wide quality goals and activities that support the achievement of those goals, identifies performance measurement strategies, and describes processes for quality program development, implementation, evaluation, and reporting.

  • 2022 Comprehensive Quality Strategy PDF | Word

Quality Strategy Effectiveness Evaluation

The Comprehensive Quality Strategy Effectiveness Evaluation follows CMS guidance provided in the Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Quality Strategy Toolkit published in June 2021.

  • 2023 Quality Strategy Effectiveness Evaluation PDF | Word

MassHealth Performance Measure Reports/Quality Reports

Summarizes and reports managed care entity (MCE) performance on select quality indicators in accordance with CFR 438.340.  Managed Care Entities include (Accountable Care Organizations, Managed Care Organizations, One Care Plans, Senior Care Option Plans, the MassHealth Behavioral Health Partnership, and the Primary Care Clinician Program.

  • Managed Care Plan Quality Performance 2022 PDF | Word
  • Managed Care Plan Quality Performance 2021 PDF | Word
  • Managed Care Plan Quality Performance 2020 PDF | Word
  • Managed Care Plan Quality Performance 2019 PDF | Word
  • Managed Care Plan Quality Performance 2018 PDF | Word 

Massachusetts State Profile

Presents key characteristics of Medicaid and CHIP in Massachusetts, including documents and information relevant to how the programs have been implemented by Massachusetts within federal guidelines as well as performance on frequently-reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets in Massachusetts.

https://www.medicaid.gov/state-overviews/stateprofile.html?state=massachusetts

MassHealth External Quality Review

Summarizes Managed Care Plan performance on mandatory and optional external quality activities.

2022 Technical Reports
  • Accountable Care Partnership Plans (ACPP) EQR Technical Report PDF | Word
  • Massachusetts Behavioral Health Partnership (MBHP) EQR Technical Report PDF | Word
  • Managed Care Organizations (MCO) EQR Technical Report PDF | Word
  • MassHealth One Care EQR Technical Report PDF | Word
  • Primary Care Accountable Care Organizations (PCACO) EQR Technical Report PDF | Word
  • Primary Care Clinician (PCC) Plan EQR Technical Report PDF | Word
  • MassHealth Senior Care Organizations (SCO) EQR Technical Report PDF | Word
2021 Technical Reports
  • Accountable Care Partnership Plans (ACPP) EQR Technical Report PDF | Word
  • Massachusetts Behavioral Health Partnership (MBHP) EQR Technical Report PDF | Word
  • Managed Care Organizations (MCO) EQR Technical Report PDF | Word
  • MassHealth One Care EQR Technical Report PDF | Word
  • Primary Care Accountable Care Organizations (PCACO) EQR Technical Report PDF | Word
  • Primary Care Clinician (PCC) Plan EQR Technical Report PDFWord
  • MassHealth Senior Care Organizations (SCO) EQR Technical Report PDF | Word
2020 Technical Reports
  • Accountable Care Partnership Plans (ACPP) EQR Technical Report PDF | Word
  • Massachusetts Behavioral Health Partnership (MBHP) EQR Technical Report PDF | Word
  • Managed Care Organizations (MCO) EQR Technical Report PDF | Word
  • MassHealth One Care EQR Technical Report PDF | Word
  • Primary Care Accountable Care Organizations (PCACO) EQR Technical Report PDF | Word
  • Primary Care Clinician (PCC) Plan EQR Technical Report PDF | Word
  • MassHealth Senior Care Organizations (SCO) EQR Technical Report PDF | Word
2019 Technical Reports
  • Accountable Care Partnership Plans (ACPP) EQR Technical Report PDF | Word
  • Massachusetts Behavioral Health Partnership (MBHP) EQR Technical Report PDF | Word
  • Managed Care Organizations (MCO) EQR Technical Report PDF | Word
  • MassHealth One Care EQR Technical Report PDF | Word
  • Primary Care Accountable Care Organizations (PCACO) EQR Technical Report PDF | Word
  • Primary Care Clinician (PCC) Plan EQR Technical Report PDFWord
  • MassHealth Senior Care Organizations (SCO) EQR Technical Report PDF | Word
2018 Technical Reports
  • Massachusetts Behavioral Health Partnership (MBHP) EQR Technical Report PDF | Word
  • Managed Care Organizations (MCO) EQR Technical Report PDF | Word
  • MassHealth One Care EQR Technical Report PDF | Word
  • Primary Care Clinician (PCC) Plan EQR Technical Report PDF | Word
  • MassHealth Senior Care Organizations (SCO) EQR Technical Report PDF | Word
2017 Technical Reports
  • Massachusetts Behavioral Health Partnership (MBHP) EQR Technical Report PDF | Word
  • MassHealth Managed Care Organizations (MCO) EQR Technical Report PDF | Word
  • MassHealth One Care EQR Technical Report PDF | Word
  • Primary Care Clinician (PCC) Plan EQR Technical Report PDF | Word
  • MassHealth Senior Care Organizations (SCO) EQR Technical Report PDF | Word

Accreditation

Provides information about the accreditation status of MassHealth Managed Care Plans in accordance with 42 CFR § 438.332.

  • Accreditation Status of MassHealth Managed Care Entities PDF | Word

Member Experience and Survey Data

Existing information can be found in the 2022 Technical Reports. More information to come.

CMS Core Set Chart Packs

Each year, MassHealth reports on the CMS Adult and Child Core Sets.  CMS publishes through an annual review and selection process (PDF, 110.85 KB), sets of core measures showing the quality of care and health outcomes for adults participating in Medicaid, and children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) for all reporting states including Massachusetts.

Additional Resources

Last updated: February 28, 2024

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