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DLS backs MDH scrutiny of MCO HEDIS declines; MDH adds health-equity accreditation and new incentives
Summary
DLS highlighted a decline in MCO HEDIS performance and recommended reducing some unallocated incentive funds; MDH said it will require health-equity accreditation for MCOs in 2025 and expects alignment of future incentives with the AHEAD primary care model.
The Department of Legislative Services told the Health and Social Services Subcommittee that Maryland’s managed care organizations (MCOs) reported declines on many HEDIS quality measures in calendar 2023 and that more than half of HealthChoice enrollees were in the four lowest-performing plans. DLS asked MDH to explain the decline and to describe how it will determine whether HEDIS problems merit penalties or other corrective action.
Anne Braun summarized DLS’s review of the Population Health Incentive Program (PHIP), which allows MCOs to earn a percentage of their capitated rates for meeting performance benchmarks. Braun said exhibit…
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