HMO Reporting
HMO Quality Audits and HEDIS Measures

Quality reporting to the public is completed through Quality Audits every three years, and annual review of Healthcare Effectiveness Data and Information Set (HEDIS) quality measures.

Quality Assurance Reports

 The most recent Quality Audit from each HMO and CPB can be found below. Quality Audits are conducted every three years; if a health plan is found to not meet all requirements (deficiencies), then a mid-cycle exam, approximately 18 months after the initial exam, is conducted, to ensure that the HMO or CPB has taken necessary steps so that they meet all requirements. MDH also conducts Triennial Compliance reports for HMOs and CPBs that provide coverage to enrollees in the state Medical Assistance (Medicaid) and MinnesotaCare programs, on behalf of the Minnesota Department of Human Services. 

HEDIS

The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool created by the National Committee for Quality Assurance (NCQA) to collect data about the quality of care and services provided by the health plans. HEDIS consists of a set of performance measures that compare how well health plans perform in key areas: quality of care, access to care and member satisfaction with the health plan and doctors. NCQA requires health plans to collect this information in the same manner so that results can be fairly compared to one another. Health plans can arrange to have their HEDIS results verified by an independent auditor.

For more information, or to request copies of reports from previous years, email health.mcs@state.mn.us. MDH maintains Quality Assurance Audit reports for 6 years.