Common use of Cost and Quality Information Clause in Contracts

Cost and Quality Information. The Contractor must make cost and quality information available to members in order to facilitate more responsible use of health care services and inform health care decision- making. Examples of cost information include average cost of common services and urgent versus emergent care costs. 4.1. Specific services for member verification may be identified by the OMPP PI Unit and may change based upon fraud trends. Processes for verifying services with members shall be included in the Contractor’s Program Integrity Plan. The Contractor shall provide a member portal with access to electronic EOB statements for Hoosier Care Connect members. Provider quality information must also be made available to members beginning in the second calendar year of the Contract. The Contractor must capture quality information about its network providers, and must make this information available to members. In making the information available to members, the Contractor must identify any limitations of the data. The Contractor must also refer members to quality information compiled by credible external entities such as CMS Hospital Compare or Leapfrog Group. Respondents should identify proposed strategies to provide cost and quality information to members and specify if explanation of benefits (EOBs) will be provided.

Cost and Quality Information. The Contractor must make cost and quality information available to members in order to facilitate more responsible use of health care services and inform health care decision- making. Examples of cost information include average cost of common services and urgent versus emergent care costs. 4.1. Specific services for member verification may be identified by the OMPP PI Unit and may change based upon fraud trends. Processes for verifying services with members shall be included in the Contractor’s Program Integrity Plan. The Contractor shall provide a member portal with access to electronic EOB statements for Hoosier Care Connect members. Provider quality information must also be made available to members beginning in the second calendar year of the Contract. The Contractor must capture quality information about its network providers, and must make this information available to members. In making the information available to members, the Contractor must identify any limitations of the data. The Contractor must also refer members to quality information compiled by credible external entities such as CMS Hospital Compare or Leapfrog Group. Respondents should identify proposed strategies to provide cost and quality information to members and specify if explanation of benefits (EOBs) will be provided.. EXHIBIT 1.M SCOPE OF WORK