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MetaStar validates managed care organization (MCO) and health maintenance organization (HMO) performance measures that have been reported by the MCOs/HMOs during the preceding 12 months. Validating performance measures is a mandatory EQR activity used to assess the accuracy of performance measures reported by the MCO, and to determine the extent to which performance measures calculated by the MCO follow state specifications and reporting requirements. This helps ensure MCOs have the capacity to gather and report data accurately, so that staff and management are able to rely on data when assessing program performance or making decisions related to improving members’ health, safety, and quality of care.
MetaStar conducts validation activities as outlined in the CMS guide, MetaStar uses the Centers for Medicare & Medicaid Services (CMS) guide, External Quality Review Protocol 2: Validation of Measures Reported by the MCO (2012).
As requested by Wisconsin DHS MetaStar validates performance measures submitted by MCOs/HMOs, in order to ensure the accuracy and reliability of the measures, and to provide recommendations to the MCOs/HMOs in order to improve performance measures monitoring.