MLTC & Healthcare: Quality Incentives. Get all the rewards your plan deserves.

Updated: Jun 30



When somebody talks about Quality Incentives, what do you think?

Of course, right away your mind collapses to a single thought: money.


And money is a very important subject in different markets. How the money comes in? There are many ways, the most simple one is clients. A second option is incentives for quality.


For the MLTC plans in the state of New York incentives represent a challenging competition. Those incentives are based on 4 different areas, each area grouping different measures.


In recent times, the number of measures considered for QI has been reduced, but the competition is still extremely hard.


The difficulty comes from the fact that is a direct competition among all plans participating in the MLTC program. In the last measurement period, the number of plans is a little higher than 50. On top of this, there is a calculation where depending on the rate obtained by every plan in a specific measurement period and a specific measure, compared to the Statewide rate, a certain number of points can be awarded.


As I mentioned before there are 4 areas to calculate Quality Incentives, which cover in total 20 measures.



For Quality measures, every measure can be granted a maximum of 5 points. But how are those points granted? In the following table I present the distribution of points


For example, we will consider a measure that used to be in the Quality Measures areas, No Emergency Room visits. We present the results per plan and the cut off lines for the percentiles for the last two measurement periods, January - June and July - December 2018.



The first dashed line from left to right represents the 50th percentile, the second line, the 75th percentile, and the last line represents the 90th percentile. In this case for both measurement periods, the percentiles are the same 93, 94 and 95 respectively.


What this means is that all plans to the left of the first line would get 0 points in this measure. Plans on the first line and less than the second line will get 50% of the possible total points, 2.5 points. On the second lines and less than the third line will get 75% of possible points, 3.75 and plans with results on the third line and larger than 95 will obtain 100% of possible points, 5.


You do this kind of calculation for every measure in every area, sum the total of points each plan obtained, and then the tiers with respect to those results are obtained for the assignment of Quality Incentives


If you want to go in deep in this calculation on Quality Incentives







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