Quality Assurance & Reporting Requirements
QHI ACO maintains a comprehensive physician-directed and beneficiary-centered Quality Assurance and Improvement Program that includes performance standards for: (1) quality of care, (2) patient experiences and (3) cost-effectiveness.
QHI ACO emphasizes adherence to evidence-based clinical guidelines and care delivery processes that focus on the needs of individual beneficiaries while maintaining a perspective on the broader population the ACO serves. The QHI ACO Medical Director reports all findings to the board which directs the Quality Assurance and Improvement Program.
QHI ACO utilizes and follows all NCQA standards and guidelines, and all MSSP quality-related recommendations/regulations. QHI ACO and all preferred vendors maintain appropriate protection of health information, including the removal of member names, when providing benchmark, historical, and comparative data for ongoing quality improvement.
Click on the following topics for additional information, where available:
- QHI ACO Quality Assurance Policy
- Provider Response for Quality Reporting
- CMS CAHPS Survey for ACOs
Compliance & Ethics
Purpose: To describe the processes designed to oversee and ensure compliance with all applicable federal and state rules, regulations and laws, as well as CMS rules and regulations for the QHI ACO, its practices and participating providers.
Policy: As part of the ACO’s participation in the MSSP, it is required to develop and maintain an effective comprehensive compliance program to detect, correct and prevent incidences of non-compliance with the requirements of the MSSP, and address potential incidences of fraud, waste and abuse relating to the MSSP and federal health care programs. This ACO Compliance Program, “ACO CP” is specific to ACO operations. The ACO CP shall remain in compliance with, and be updated periodically to reflect changes in applicable laws and regulations.
Click on the following topics for additional information, where available:
- Compliance and Ethics Training Material
- QHI ACO Compliance including Annual Certificiation Forms