Furthermore, NCQA does not require MCOs to demonstrate a particular percentage improvement for an activity to be considered meaningful. Even if the MCO's goals are not met, an improvement can be considered meaningful. Consequently, the improvement must be associated with an appropriate study design and baseline measurement, an analysis of the study results, an appropriate intervention and a remeasurement that demonstrates the improvement. To demonstrate that an improvement is meaningful, the MCO must show that the study it used to determine meaningfulness is sound. There are many ways that an MCO can improve care and service.
Opportunities abound to address a host of issues, from asthma to accessibility.
Given the competing demands for attention, an MCO must thoughtfully consider which problems it wishes to address and why. And if the MCO decides to tackle issues with larger regional or national significance, it must show that these issues are also relevant to its own members. The MCO should focus on problems where improvement can be expected and should avoid focusing on problems that are relatively easy to address. This evidence can include prepublication studies. To determine this intervention, the MCO can review ambulatory, hospital or pharmacy claims data.