Common use of Quality Improvement Plans Clause in Contracts

Quality Improvement Plans. a) Upon notification of required improvement as specified in 5.2.3 and Attachment 4 – Quality Transformation Initiative, Contractor must submit a Quality Improvement Plan to Covered California detailing the action(s) it plans to take to improve quality. b) For each product that has failed to meet the Measurement Year 2018 25th percentile composite benchmark for the QRS Clinical Quality Management Summary Indicator measures for two (2) consecutive years, the Quality Improvement Plan must include annual targets for measure score improvement and describe actions to improve specific measures or describe systemic improvement efforts intended to improve performance on multiple applicable measures. c) For each QTI core measure for which Contractor scores below 25th percentile national benchmark, the Quality Improvement Plan must include annual targets for measure score improvement and describe the quality improvement activities intended to improve performance on that specific QTI core measure in accordance with Attachment 4 – Quality Transformation Initiative. d) Contractor’s Quality Improvement Plan must detail the actions that it is undertaking, or will undertake, to improve quality in each of the following: i. Engaging and supporting providers including physicians and physician groups, in improvement activities, for example development of registries and data analytics, facilitating data exchange, and innovative approaches to patient engagement to improve coordination, integration, and care delivery; ii. Contracting with higher performing providers; iii. Developing or building on existing quality incentive programs for contracted providers that include or focus on measures in the QTI core measure set or other QRS Clinical Quality Management Summary Indicator measures; iv. Using consumer incentive programs to target desired behavior change that could impact the QTI core measure set or other QRS Clinical Quality Management Summary Indicator measures; v. Improving data quality and completeness; and vi. Eliminating providers from its networks based on their poor performance. To the extent this strategy is undertaken, Contractor must explicitly identify in the Quality Improvement Plan any providers, including individual physicians and physician groups, identified as poor performing that Contractor is considering for removal from its QHP network if quality performance does not improve. If these providers are designated ECPs or serve predominantly low-income or vulnerable Enrollee populations, the Quality Improvement Plan must outline how planned activities, strategies, and resources will be tailored to meet the unique needs of providers serving these communities. Any removal of contracted providers is subject to notice requirements as specified in 4.3.3 Network Stability and 4.3.4 Essential Community Providers of this contract. e) Covered California reserves the right to approve or reject the Quality Improvement Plan and request amendments. Upon receipt of the Quality Improvement Plan, Covered California will approve the Quality Improvement Plan or advise Contractor of any deficiencies. Contractor must resolve any identified deficiencies to Covered California’s satisfaction within thirty (30) business days. f) Contractor must regularly report to Covered California on its progress in implementing the Quality Improvement Plan and achieving the annual targets for improvement, in writing and on a recurring basis as specified by Covered California. g) Covered California will work with Contractor to ensure its Quality Improvement Plan does not negatively impact Enrollees. h) Covered California will closely monitor Contractor actions following approval of the Quality Improvement Plan. Monitoring will include review of specified progress reports and evaluation of Contractor compliance and performance in contractual and regulatory requirements, with particular oversight of Contractor’s QHP network. i) Contractor poor performance identified in Covered California’s assessments and any documented pattern of actions negatively impacting Enrollees or contracted providers may result in early removal of Contractor’s products from the Exchange, prior to the conclusion of the remediation period.

Quality Improvement Plans. a) Upon notification of required improvement as specified in 5.2.3 and Attachment 4 – Quality Transformation Initiative, Contractor must submit a Quality Improvement Plan to Covered California detailing the action(s) it plans to take to improve quality. b) For each product that has failed to meet the Measurement Year 2018 25th percentile composite benchmark for the QRS Clinical Quality Management Summary Indicator measures for two (2) consecutive years, the Quality Improvement Plan must include annual targets for measure score improvement and describe actions to improve specific measures or describe systemic improvement efforts intended to improve performance on multiple applicable measures. c) For each QTI core measure for which Contractor scores below 25th percentile national benchmark, the Quality Improvement Plan must include annual targets for measure score improvement and describe the quality improvement activities intended to improve performance on that specific QTI core measure in accordance with Attachment 4 – — Quality Transformation Initiative. d) Contractor’s Quality Improvement Plan must detail the actions that it is undertaking, or will undertake, to improve quality in each of the following: i. Engaging and supporting providers including physicians and physician groups, in improvement activities, for example development of registries and data analytics, facilitating data exchange, and innovative approaches to patient engagement to improve coordination, integration, and care delivery; ii. Contracting with higher performing providers; iii. Developing or building on existing quality incentive programs for contracted providers that include or focus on measures in the QTI core measure set or other QRS Clinical Quality Management Summary Indicator measures; iv. Using consumer incentive programs to target desired behavior change that could impact the QTI core measure set or other QRS Clinical Quality Management Summary Indicator measures; v. Improving data quality and completeness; and vi. Eliminating providers from its networks based on their poor performance. To the extent this strategy is undertaken, Contractor must explicitly identify in the Quality Improvement Plan any providers, including individual physicians and physician groups, identified as poor performing that Contractor is considering for removal from its QHP network if quality performance does not improve. If these providers are designated ECPs or serve predominantly low-income or vulnerable Enrollee populations, the Quality Improvement Plan must outline how planned activities, strategies, and resources will be tailored to meet the unique needs of providers serving these communities. Any removal of contracted providers is subject to notice requirements as specified in 4.3.3 Network Stability and 4.3.4 Essential Community Providers of this contract. e) Covered California reserves the right to approve or reject the Quality Improvement Plan and request amendments. Upon receipt of the Quality Improvement Plan, Covered California will approve the Quality Improvement Plan or advise Contractor of any deficiencies. Contractor must resolve any identified deficiencies to Covered California’s satisfaction within thirty (30) business days. f) Contractor must regularly report to Covered California on its progress in implementing the Quality Improvement Plan and achieving the annual targets for improvement, in writing and on a recurring basis as specified by Covered California. g) Covered California will work with Contractor to ensure its Quality Improvement Plan does not negatively impact Enrollees. h) Covered California will closely monitor Contractor actions following approval of the Quality Improvement Plan. Monitoring will include review of specified progress reports and evaluation of Contractor compliance and performance in contractual and regulatory requirements, with particular oversight of Contractor’s QHP network. i) Contractor poor performance identified in Covered California’s assessments and any documented pattern of actions negatively impacting Enrollees or contracted providers may result in early removal of Contractor’s products from the Exchange, prior to the conclusion of the remediation period.

Quality Improvement Plans. ‌ a) Upon notification of required improvement as specified in 5.2.3 and Attachment 4 – Quality Transformation Initiative, Contractor must submit a Quality Improvement Plan or Minimum Performance Level Action Plan to Covered California detailing the action(s) it plans to take to improve quality. b) For each product that has failed to meet the Measurement Year 2018 CMS QRS measure for which Contractor scores below 25th percentile composite benchmark for the QRS Clinical Quality Management Summary Indicator measures national benchmark, for two (2) consecutive years, the a Minimum Performance Level Action Plan (MPL) will be required. This Quality Improvement Plan must include annual targets for measure score improvement above the 25th percentile and describe actions to improve specific measures or describe systemic the quality improvement efforts activities intended to improve performance on multiple applicable measuresthat specific clinical measure in accordance with Attachment 4. c) For each QTI core measure Scored Measure, for which Contractor scores scored below 25th percentile national benchmark, for one year, the Quality Improvement Plan will be required. This Quality Improvement Plan must include annual targets for measure score improvement above the 25th percentile and describe the quality improvement activities intended to improve performance on that specific QTI core measure Scored Measure in accordance with Attachment 4 – Quality Transformation Initiative. d) Contractor’s Quality Improvement Plan or Minimum Performance Level Action Plan must detail the actions that it is undertaking, or will undertake, to improve quality in each of the followingsuch as: e) QHP Issuer’s root cause or gap analysis for each required clinical measure detailing the factors contributing to repeated poor quality performance. f) Which Quality Collaboratives from Attachment 1 Article 4.04 are or will be involved i. Engaging A detailed outline and supporting timeline of quality improvement interventions and health equity efforts and infrastructure across the organization to support measure improvement. ii. Engagement and support for providers including physicians and physician groups, in improvement activities, for example development of registries and data analytics, facilitating data exchange, and innovative approaches to patient engagement to improve coordination, integration, and care delivery; iiiii. Contracting with higher performing providers; iiiiv. Developing or building on existing quality incentive programs for contracted providers that include or focus on measures in the QTI core measure set Core Measures, specified in Attachment 4, or other QRS Clinical Quality Management Summary Indicator measures; iv. v. Using consumer incentive programs to target desired behavior change that could impact the QTI core measure set Scored Measures or other QRS Clinical Quality Management Summary Indicator measures; v. vi. Improving data quality and completeness; and vivii. Eliminating providers from its networks based on their poor performance. To the extent this strategy is undertaken, Contractor must explicitly identify in the Minimum Performance Level Action Plan and Quality Improvement Plan any providers, including individual physicians and physician groups, identified as poor performing that Contractor is considering for removal from its QHP network if quality performance does not improve. If these providers are designated ECPs or serve predominantly low-income or vulnerable Enrollee populations, the Quality Improvement Plan must outline how planned activities, strategies, and resources will be tailored to meet the unique needs of providers serving these communities. Any removal of contracted providers is subject to notice requirements as specified in 4.3.3 Network Stability and 4.3.4 Essential Community Providers of this contract. e) Covered California reserves the right to approve or reject the Quality Improvement Plan and request amendments. Upon receipt of the Quality Improvement Plan, Covered California will approve the Quality Improvement Plan or advise Contractor of any deficiencies. Contractor must resolve any identified deficiencies to Covered California’s satisfaction within thirty (30) business days. f) Contractor must regularly report to Covered California on its progress in implementing the Quality Improvement Plan and achieving the annual targets for improvement, in writing and on a recurring basis as specified by Covered California. g) Covered California will work with Contractor to ensure its Quality Improvement Plan does not negatively impact Enrollees. h) Covered California will closely monitor Contractor actions following approval of the Quality Improvement Plan. Monitoring will include review of specified progress reports and evaluation of Contractor compliance and performance in contractual and regulatory requirements, with particular oversight of Contractor’s QHP network. i) Contractor poor performance identified in Covered California’s assessments and any documented pattern of actions negatively impacting Enrollees or contracted providers may result in early removal of Contractor’s products from the Exchange, prior to the conclusion of the remediation period.

Quality Improvement Plans. ‌ a) Upon notification of required improvement as specified in 5.2.3 and Attachment 4 – Quality Transformation Initiative, Contractor must submit a Quality Improvement Plan to Covered California detailing the action(s) it plans to take to improve quality. b) For each product that has failed to meet the Measurement Year 2018 25th percentile composite benchmark for the QRS Clinical Quality Management Summary Indicator measures for two (2) consecutive years, the Quality Improvement Plan must include annual targets for measure score improvement and describe actions to improve specific measures or describe systemic improvement efforts intended to improve performance on multiple applicable measures. c) For each QTI core measure for which Contractor scores below 25th percentile national benchmark, the Quality Improvement Plan must include annual targets for measure score improvement and describe the quality improvement activities intended to improve performance on that specific QTI core measure in accordance with Attachment 4 – — Quality Transformation Initiative. d) Contractor’s Quality Improvement Plan must detail the actions that it is undertaking, or will undertake, to improve quality in each of the following: i. Engaging and supporting providers including physicians and physician groups, in improvement activities, for example development of registries and data analytics, facilitating data exchange, and innovative approaches to patient engagement to improve coordination, integration, and care delivery; ii. Contracting with higher performing providers; iii. Developing or building on existing quality incentive programs for contracted providers that include or focus on measures in the QTI core measure set or other QRS Clinical Quality Management Summary Indicator measures; iv. Using consumer incentive programs to target desired behavior change that could impact the QTI core measure set or other QRS Clinical Quality Management Summary Indicator measures; v. Improving data quality and completeness; and vi. Eliminating providers from its networks based on their poor performance. To the extent this strategy is undertaken, Contractor must explicitly identify in the Quality Improvement Plan any providers, including individual physicians and physician groups, identified as poor performing that Contractor is considering for removal from its QHP network if quality performance does not improve. If these providers are designated ECPs or serve predominantly low-income or vulnerable Enrollee populations, the Quality Improvement Plan must outline how planned activities, strategies, and resources will be tailored to meet the unique needs of providers serving these communities. Any removal of contracted providers is subject to notice requirements as specified in 4.3.3 Network Stability and 4.3.4 Essential Community Providers of this contract. e) Covered California reserves the right to approve or reject the Quality Improvement Plan and request amendments. Upon receipt of the Quality Improvement Plan, Covered California will approve the Quality Improvement Plan or advise Contractor of any deficiencies. Contractor must resolve any identified deficiencies to Covered California’s satisfaction within thirty (30) business days. f) Contractor must regularly report to Covered California on its progress in implementing the Quality Improvement Plan and achieving the annual targets for improvement, in writing and on a recurring basis as specified by Covered California. g) Covered California will work with Contractor to ensure its Quality Improvement Plan does not negatively impact Enrollees. h) Covered California will closely monitor Contractor actions following approval of the Quality Improvement Plan. Monitoring will include review of specified progress reports and evaluation of Contractor compliance and performance in contractual and regulatory requirements, with particular oversight of Contractor’s QHP network. i) Contractor poor performance identified in Covered California’s assessments and any documented pattern of actions negatively impacting Enrollees or contracted providers may result in early removal of Contractor’s products from the Exchange, prior to the conclusion of the remediation period.

Quality Improvement Plans. a) Upon notification of required improvement as specified in 5.2.3 and Attachment 4 – Quality Transformation Initiative, Contractor must submit a Quality Improvement Plan to Covered California detailing the action(s) it plans to take to improve quality. b) For each product that has failed to meet the Measurement Year 2018 25th percentile composite benchmark for the QRS Clinical Quality Management Summary Indicator measures for two (2) consecutive years, the Quality Improvement Plan must include annual targets for measure score improvement and describe actions to improve specific measures or describe systemic improvement efforts intended to improve performance on multiple applicable measures. c) For each QTI core measure for which Contractor scores below 25th percentile national benchmark, the Quality Improvement Plan must include annual targets for measure score improvement and describe the quality improvement activities intended to improve performance on that specific QTI core measure in accordance with Attachment 4 – Quality Transformation Initiative. d) Contractor’s Quality Improvement Plan must detail the actions that it is undertaking, or will undertake, to improve quality in each of the following: i. Engaging and supporting providers including physicians and physician groups, in improvement activities, for example development of registries and data analytics, facilitating data exchange, and innovative approaches to patient engagement to improve coordination, integration, and care delivery; ii. Contracting with higher performing providers; iii. Developing or building on existing quality incentive programs for contracted providers that include or focus on measures in the QTI core measure set or other QRS Clinical Quality Management Summary Indicator measures; iv. Using consumer incentive programs to target desired behavior change that could impact the QTI core measure set or other QRS Clinical Quality Management Summary Indicator measures; v. Improving data quality and completeness; and vi. Eliminating providers from its networks based on their poor performance. To the extent this strategy is undertaken, Contractor must explicitly identify in the Quality Improvement Plan any providers, including individual physicians and physician groups, identified as poor performing that Contractor is considering for removal from its QHP network if quality performance does not improve. If these providers are designated ECPs or serve predominantly low-income or vulnerable Enrollee populations, the Quality Improvement Plan must outline how planned activities, strategies, and resources will be tailored to meet the unique needs of providers serving these communities. Any removal of contracted providers is subject to notice requirements as specified in 4.3.3 Network Stability and 4.3.4 Essential Community Providers of this contract. e) Covered California reserves the right to approve or reject the Quality Improvement Plan and request amendments. Upon receipt of the Quality Improvement Plan, Covered California will approve the Quality Improvement Plan or advise Contractor of any deficiencies. Contractor must resolve any identified deficiencies to Covered California’s satisfaction within thirty (30) business days. f) Contractor must regularly report to Covered California on its progress in implementing the Quality Improvement Plan and achieving the annual targets for improvement, in writing and on a recurring basis as specified by Covered California. g) Covered California will work with Contractor to ensure its Quality Improvement Plan does not negatively impact Enrollees. h) Covered California will closely monitor Contractor actions following approval of the Quality Improvement Plan. Monitoring will include review of specified progress reports and evaluation of Contractor compliance and performance in contractual and regulatory requirements, with particular oversight of Contractor’s QHP network. i) Contractor poor performance identified in Covered California’s assessments and any documented pattern of actions negatively impacting Enrollees or contracted providers may result in early removal of Contractor’s products from the Exchange, prior to the conclusion of the remediation period.

Quality Improvement Plans. ‌ a) Upon notification of required improvement as specified in 5.2.3 and Attachment 4 – Quality Transformation Initiative, Contractor must submit a Quality Improvement Plan or Minimum Performance Level Action Plan to Covered California detailing the action(s) it plans to take to improve quality. b) For each product that has failed to meet the Measurement Year 2018 CMS QRS measure for which Contractor scores below 25th percentile composite benchmark for the QRS Clinical Quality Management Summary Indicator measures national benchmark, for two (2) consecutive years, a Minimum Performance Level Action Plan (MPL) will be required. This Quality Improvement PlanMPL must include annual targets for measure score improvement above the 25th percentile and describe the quality improvement activities intended to improve performance on that specific clinical measure in accordance with Attachment 4. c) For each QTI Scored Measure, for which Contractor scored below 25th percentile national benchmark, for one year, the Quality Improvement Plan will be required. This Quality Improvement Plan must include annual targets for measure score improvement and describe actions to improve specific measures or describe systemic improvement efforts intended to improve performance on multiple applicable measures. c) For each QTI core measure for which Contractor scores below above the 25th percentile national benchmark, the Quality Improvement Plan must include annual targets for measure score improvement and describe the quality improvement activities intended to improve performance on that specific QTI core measure Scored Measure in accordance with Attachment 4 – Quality Transformation Initiative. d) Contractor’s Quality Improvement Plan or Minimum Performance Level Action Plan must detail the actions that it is undertaking, or will undertake, to improve quality in each of the followingsuch as: e) QHP Issuer’s root cause or gap analysis for each required clinical measure detailing the factors contributing to repeated poor quality performance. f) Which Quality Collaboratives from Attachment 1 Article 4.04 are or will be involved i. Engaging A detailed outline and supporting timeline of quality improvement interventions and health equity efforts and infrastructure across the organization to support measure improvement. ii. Engagement and support for providers including physicians and physician groups, in improvement activities, for example development of registries and data analytics, facilitating data exchange, and innovative approaches to patient engagement to improve coordination, integration, and care delivery; iiiii. Contracting with higher performing providers; iiiiv. Developing or building on existing quality incentive programs for contracted providers that include or focus on measures in the QTI core measure set Core Measures, specified in Attachment 4, or other QRS Clinical Quality Management Summary Indicator measures; iv. v. Using consumer incentive programs to target desired behavior change that could impact the QTI core measure set Scored Measures or other QRS Clinical Quality Management Summary Indicator measures; v. vi. Improving data quality and completeness; and vivii. Eliminating providers from its networks based on their poor performance. To the extent this strategy is undertaken, Contractor must explicitly identify in the Minimum Performance Level Action Plan and Quality Improvement Plan any providers, including individual physicians and physician groups, identified as poor performing that Contractor is considering for removal from its QHP network if quality performance does not improve. If these providers are designated ECPs or serve predominantly low-income or vulnerable Enrollee populations, the Quality Improvement Plan must outline how planned activities, strategies, and resources will be tailored to meet the unique needs of providers serving these communities. Any removal of contracted providers is subject to notice requirements as specified in 4.3.3 Network Stability and 4.3.4 Essential Community Providers of this contract. e) Covered California reserves the right to approve or reject the Quality Improvement Plan and request amendments. Upon receipt of the Quality Improvement Plan, Covered California will approve the Quality Improvement Plan or advise Contractor of any deficiencies. Contractor must resolve any identified deficiencies to Covered California’s satisfaction within thirty (30) business days. f) Contractor must regularly report to Covered California on its progress in implementing the Quality Improvement Plan and achieving the annual targets for improvement, in writing and on a recurring basis as specified by Covered California. g) Covered California will work with Contractor to ensure its Quality Improvement Plan does not negatively impact Enrollees. h) Covered California will closely monitor Contractor actions following approval of the Quality Improvement Plan. Monitoring will include review of specified progress reports and evaluation of Contractor compliance and performance in contractual and regulatory requirements, with particular oversight of Contractor’s QHP network. i) Contractor poor performance identified in Covered California’s assessments and any documented pattern of actions negatively impacting Enrollees or contracted providers may result in early removal of Contractor’s products from the Exchange, prior to the conclusion of the remediation period.

Quality Improvement Plans. ‌ a) Upon notification of required improvement as specified in 5.2.3 and Attachment 4 – Quality Transformation Initiative, Contractor must submit a Quality Improvement Plan or Minimum Performance Level Action Plan to Covered California detailing the action(s) it plans to take to improve quality. b) For each product that has failed to meet the Measurement Year 2018 CMS QRS measure for which Contractor scores below 25th percentile composite benchmark for the QRS Clinical Quality Management Summary Indicator measures national benchmark, for two (2) consecutive years, a Minimum Performance Level Action Plan (MPL) will be required. This MPL must include annual targets for measure score improvement above the 25th percentile and describe the quality improvement activities intended to improve performance on that specific clinical measure in accordance with Attachment 4. c) For each QTI Scored Measure, for which Contractor scored below 25th percentile national benchmark, for one year, the Quality Improvement Plan will be required. This Quality Improvement Plan must include annual targets for measure score improvement and describe actions to improve specific measures or describe systemic improvement efforts intended to improve performance on multiple applicable measures. c) For each QTI core measure for which Contractor scores below above the 25th percentile national benchmark, the Quality Improvement Plan must include annual targets for measure score improvement and describe the quality improvement activities intended to improve performance on that specific QTI core measure Scored Measure in accordance with Attachment 4 – Quality Transformation Initiative. d) Contractor’s Quality Improvement Plan or Minimum Performance Level Action Plan must detail the actions that it is undertaking, or will undertake, to improve quality in each of the followingsuch as: e) QHP Issuer’s root cause or gap analysis for each required clinical measure detailing the factors contributing to repeated poor quality performance. f) Which Quality Collaboratives from Attachment 1 Article 4.04 are or will be involved i. Engaging A detailed outline and supporting timeline of quality improvement interventions and health equity efforts and infrastructure across the organization to support measure improvement. ii. Engagement and support for providers including physicians and physician groups, in improvement activities, for example development of registries and data analytics, facilitating data exchange, and innovative approaches to patient engagement to improve coordination, integration, and care delivery; iiiii. Contracting with higher performing providers; iiiiv. Developing or building on existing quality incentive programs for contracted providers that include or focus on measures in the QTI core measure set Core Measures, specified in Attachment 4, or other QRS Clinical Quality Management Summary Indicator measures; iv. v. Using consumer incentive programs to target desired behavior change that could impact the QTI core measure set Scored Measures or other QRS Clinical Quality Management Summary Indicator measures; v. vi. Improving data quality and completeness; and vivii. Eliminating providers from its networks based on their poor performance. To the extent this strategy is undertaken, Contractor must explicitly identify in the Minimum Performance Level Action Plan and Quality Improvement Plan any providers, including individual physicians and physician groups, identified as poor performing that Contractor is considering for removal from its QHP network if quality performance does not improve. If these providers are designated ECPs or serve predominantly low-income or vulnerable Enrollee populations, the Quality Improvement Plan must outline how planned activities, strategies, and resources will be tailored to meet the unique needs of providers serving these communities. Any removal of contracted providers is subject to notice requirements as specified in 4.3.3 Network Stability and 4.3.4 Essential Community Providers of this contract. e) Covered California reserves the right to approve or reject the Quality Improvement Plan and request amendments. Upon receipt of the Quality Improvement Plan, Covered California will approve the Quality Improvement Plan or advise Contractor of any deficiencies. Contractor must resolve any identified deficiencies to Covered California’s satisfaction within thirty (30) business days. f) Contractor must regularly report to Covered California on its progress in implementing the Quality Improvement Plan and achieving the annual targets for improvement, in writing and on a recurring basis as specified by Covered California. g) Covered California will work with Contractor to ensure its Quality Improvement Plan does not negatively impact Enrollees. h) Covered California will closely monitor Contractor actions following approval of the Quality Improvement Plan. Monitoring will include review of specified progress reports and evaluation of Contractor compliance and performance in contractual and regulatory requirements, with particular oversight of Contractor’s QHP network. i) Contractor poor performance identified in Covered California’s assessments and any documented pattern of actions negatively impacting Enrollees or contracted providers may result in early removal of Contractor’s products from the Exchange, prior to the conclusion of the remediation period.