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.
Quality Strategy Effectiveness Evaluation
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 2023 PDF | Word
- 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.
2023 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
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 PDF| Word
- 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 PDF| Word
- 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
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.
- Core Set Chart Packs - https://www.medicaid.gov/medicaid/quality-of-care/downloads/performance-measurement/2020-adult-chart-pack.pdf
- Child Core Set - https://www.medicaid.gov/medicaid/quality-of-care/downloads/performance-measurement/2020-child-chart-pack.pdf
- Behavioral Health Core Set - https://www.medicaid.gov/medicaid/quality-of-care/downloads/2020-behavioral-health-chart-pack.pdf
- Maternity Core Set - https://www.medicaid.gov/medicaid/quality-of-care/downloads/2020-maternity-chart-pack.pdf
Additional Resources
- MassHealth Restructuring: 2021 Update Report PDF | Word
- MassHealth Restructuring: 2020 Update Report
- MassHealth provided updates on the reforms, and stakeholders had an opportunity to comment on the program during a public meeting on October 26, 2022.
- MassHealth Restructuring: 2019 Update Report
- MassHealth Restructuring: 2018 Baseline Report (Jan 2020) PDF
Last updated: | February 28, 2024 |
---|