Managed care: Quality, outcome and performance measures

Minnesota Medicaid Managed Care Comprehensive Quality Strategy

Read the 2021 Minnesota Medicaid Managed Care Comprehensive Quality Strategy (DHS-4538E) (PDF). This document describes our goals for continuous quality improvement and initiatives that will help us achieve those goals. 

Previous document for reference: 2020 Minnesota Medicaid Managed Care Comprehensive Quality Strategy (DHS-4538C) (PDF)

MCO performance improvement projects

Managed care plans contracting with DHS must conduct performance improvement projects designed to enhance care and services provided to MHCP enrollees. These projects are summarized in the Performance Improvement Projects Annual Summary Report (DHS-6646D) (PDF). Previous report for reference: 2015 report (DHS-6646C) (PDF).

MCOs’ quality improvement program websites

MCOs submit annual quality program updates to demonstrate how their quality improvement programs identify, monitor and work to improve service and clinical quality issues relevant to the MHCP enrollees. The MCOs’ quality program website URLs, linking to a public web page, are listed here. Each MCO’s quality program website describes quality improvement activities resulting in measurable, meaningful and sustained improved health care outcomes for the contracted populations.

Submit public comments to this email address: DHS.HealthCare.Research.Quality@state.mn.us (Please include the MCO’s name or the URL in the subject line.)

• Blue Plus: https://www.bluecrossmn.com/about-us/quality-improvement-program
• HealthPartners: https://www.healthpartners.com/hp/about/understanding-cost-and-quality/quality-improvement/index.html
• Itasca Medical Care: http://www.co.itasca.mn.us/657/Community
• Medica: https://www.medica.com/providers/quality-and-cost-programs/quality-improvement-program
• Hennepin Health: http://www.hennepinhealth.org/quality
• PrimeWest: https://primewest.org/annual-report
• South Country Health Alliance: http://mnscha.org/?page_id=5924
• UCare: https://www.ucare.org/about-us/quality-highlights
• UnitedHealthcare: https://www.uhccommunityplan.com/mn/quality

MSHO consumer satisfaction survey results 2019, (DHS-7396C) (PDF)
These are the results from surveys of MSHO enrollees in managed care public programs about the health care and customer service from the managed care plans. See previous reports for reference: 2018 report: (DHS-7396B) (PDF) and 2017 report: (DHS-7396A) (PDF)

Consumer satisfaction survey results 2022, (DHS-5541N) (PDF)
These are the results from surveys of people enrolled in managed care public programs about the health care and customer service from managed care plans. See previous reports for reference: 2021 report: (DHS-5541M) (PDF) and 2020 report: (DHS-5541L) (PDF) 

Summary of managed care grievance system information for calendar years 2016—2018, (DHS-6178G) (PDF)
This report summarizes enrollee grievances and appeals filed with managed care plans; notices of denial, termination or reduction sent by the plans; and managed care state fair hearings filed with DHS. Previous report for reference: 2013–2015 report, (DHS-6178D) (PDF), 2014-2016 report, (DHS-6178E) (PDF), 2015-2017 report, (DHS-6178F) (PDF)

Annual technical report for 2021 (issued April 2023), (DHS-6888I) (PDF)
The annual technical report is an independent assessment of each managed care plan's quality program strengths and weaknesses. An external quality review organization performed and reported on the assessment as required by federal regulations. See two previous reports for reference: 2020 report (issued 2022), (DHS-6888I) (PDF) and 2019 report (issued April 2021), (DHS-6888G) (PDF).

Health plan HEDIS reporting, MDH
This link goes to the Minnesota Department of Health's (MDH) website. These are yearly reports that use the Health Care Effectiveness Data Information Set (HEDIS) tool to compare how health plans perform in quality of care, access to care and member satisfaction with the health plan and doctors.

Quality assurance examinations, MDH
This link goes to MDH’s website. These are reports that examine whether state managed care plans are operating according to Minnesota law.