CMS to Monitor and Identify Best Practices in Medicare Advantage and Part D Quality Improvement Initiatives

Date: November 15, 2012

The Centers for Medicare & Medicaid Services (CMS) has contracted with Optimal Solutions Group, LLC (“Optimal”) for the Medicare Advantage and Part D Quality Oversight, Monitoring, and Best Practices task order. The purpose of this project is to support CMS in the development and implementation of monitoring tools to determine whether Medicare Advantage Organizations (MAOs) and Special Needs Plans (SNPs) have operationalized their quality improvement (QI) program as planned, and if they are using the program in order to provide quality health care to Medicare beneficiaries. Additionally, Optimal will evaluate Medicare Advantage and Prescription Drug Plan organizations that have achieved high performance in CMS’ Plan Ratings and to identify best practices that may be shared across the Part C and D programs. Organizations that have successfully demonstrated excellence across various areas of customer service, access, patient safety, and/or improved health outcomes possess critical knowledge and experience about effective operational and clinical systems that could be transferrable to other organizations. By identifying and sharing these best practices, CMS hopes to assist low-performing contracts to improve their performance in the Medicare Part C and D Plan Ratings, thereby improving the quality of care for all Medicare beneficiaries. Optimal will summarize the best practices and provide a multi-pronged training program specifically geared to transferring these best practices to low-performing contracts for implementation.

This work builds on Optimal’s on-going assessments of MAOs’ quality improvement initiatives and simulation models of the affect pay-for-performance may have on MAO’s quality improvement initiatives and healthcare quality metrics.