Performance Improvement Project Score KEPRO evaluates a MCO’s performance against a set of pre-determined criteria. The Technical Reviewer assigns a score to each individual rating criterion. The Reviewer rates individual standards as either 1 (does not meet item criteria); 2 (partially meets item criteria); or 3 (meets item criteria). A rating score is calculated by dividing the sum of all available points by the sum of all points received. This ratio is presented as a percentage. Fallon Health received a rating score of 100% on its AMM PIP. Exhibit 62: Fallon Health MCO’s AMM PIP Scores Results of Validation Ratings Number of Total Points Rating (for Y/N Values) Items Available Scored Averages Points General Information 1 1 1 100% Reassessing Intervention 3 3 3 100% Parameters & Strategies Performance Indicator Data 3 3 3 100% Collection Validation Rating Score (for 7 7 7 100% Y/N Items) Summary Results of Validation Number of Total Available Points Rating Ratings (for 3, 2, or 1 Values) Items Points Scored Averages Reassessing PIP Goals & 5 15 15 100% Barriers Reassessing Intervention 4 12 12 100% Parameters & Strategies Performance Indicator 1 3 3 100% Parameters Performance Indicator Data 4 12 12 100% Analysis Performance Indicator Results 1 3 3 100% Member Population Analysis 2 6 6 100% Conclusions & Future PIP 4 12 12 100% Improvements Rating Score for (3, 2, or 1 21 63 63 100% Values) Overall Validation Rating Score 34 74 74 100% Updates on 2016 Recommendations
Performance Improvement Project Score KEPRO evaluates a MCO’s performance against a set of pre-determined criteria. The Technical Reviewer assigns a score to each individual rating criterion. The Reviewer rates individual standards as either 1 (does not meet item criteria); 2 (partially meets item criteria); or 3 (meets item criteria). A rating score is calculated by dividing the sum of all available points by the sum of all points received. This ratio is presented as a percentage. Fallon Health received a rating score of 100% on its AMM PIP. Exhibit 62: Fallon Health MCO’s AMM PIP Scores Results of Validation Ratings (for Y/N Values) Number of Items Total Available Points Points Scored Rating Averages General Information 1 1 1 100% Reassessing Intervention Parameters & Strategies 3 3 3 100% Performance Indicator Data Collection 3 3 3 100% Validation Rating Score (for Y/N Items) 7 7 7 100% Summary Results of Validation Ratings (for 3, 2, or 1 Values) Number of Items Total Available Points Points Scored Rating Averages Reassessing PIP Goals & Barriers 5 15 15 100% Reassessing Intervention Parameters & Strategies 4 12 12 100% Performance Indicator Parameters 1 3 3 100% Performance Indicator Data Analysis 4 12 12 100% Performance Indicator Results 1 3 3 100% Member Population Analysis 2 6 6 100% Conclusions & Future PIP Improvements 4 12 12 100% Rating Score for (3, 2, or 1 Values) 21 63 63 100% Overall Validation Rating Score 34 74 74 100% Updates on 2016 Recommendations
2017-mco-eqr-technical-report_0.docx