As stewards of public trust and funds, PrimeWest Health is held accountable for the quality of the health care services we cover for our members. As such, audits occur on a regular basis and results are made available to the public. To learn more about audit standards or to see recent audit reports, click on the links below.

Managed Care Public Programs Quality Strategy 
Information about Minnesota Department of Human Services' (DHS) standards and oversight.

Minnesota Department of Health (MDH) Quality Assurance Examination Audit
This report is MDH's assessment of PrimeWest Health to determine whether it is operating in accordance with State and Federal laws.

Annual Technical Report (ATR)
This report is the Michigan Peer Review Organization's (MPRO) assessment of State and federally mandated activities related to the unifying framework: structure, process, and outcomes. This framework serves as the foundation for MPRO's recommendations to help organizations maintain and improve timeliness, quality, and access to health care services. The assessment consists of an inventory of activities and programs set forth in the Minnesota Department of Human Services/Managed Care Organization Contract and the Balanced Budget Act (BBA).

Healthcare Effectiveness Data and Information Set (HEDIS) Audit Summary
HEDIS is one of the most widely used set of health care performance measures in the United States. It is developed and maintained by the National Committee for Quality Assurance (NCQA). These measures are designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans. The performance measures in HEDIS are related to many significant public health issues such as cancer, heart disease, smoking, asthma, and diabetes. HEDIS also includes a standardized survey of consumers' experiences that evaluates plan performance in areas such as customer service, access to care, and claims processing.

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey

Medicare Advantage CAHPS Survey
The CAHPS Survey measures members' satisfaction with their care in areas such as claims processing, customer service, and getting needed care quickly.

Medicare Health Outcomes Survey (HOS-M)
The Modified Health Outcomes Survey (HOS-M) is a survey that the Centers for Medicare & Medicaid Services (CMS) requires health plans for dual eligible members to participate in. It collects information on dually eligible members who are ages 55 and over and are living in the community. It uses this information to calculate frailty factors that are then used by CMS in conjunction with the diagnosis-based risk adjustment formula for health plan payment purposes. HOS-M is also used to assess a health plan's ability to maintain or improve the physical and mental health functioning of its dually eligible members.

Quality Report 
This report is for our providers and partners and covers quality initiatives as well as member outcomes from the past year.

Annual Report
The Annual Report is sent to members each year. It is an overview of PrimeWest Health events, quality initiatives, and financial information from the past year.

Medical Record Audits/Site Visit Reports
PrimeWest Health performs regular Medical Record Audits and Site Visits at provider locations. These reports provide the results of the completed audits and site visits.

Quality Plan
This document presents the written Quality Assurance Plan and describes the PrimeWest Health Quality program. Our Quality Plan was developed in accordance with State and Federal requirements as well as National Committee for Quality Assurance (NCQA) standards.

In addition to the Quality Plan itself, our Credentialing Plan and Utilization Management Plan contain further descriptions of our Quality program.

Model of Care Summary Presentation
This presentation is a summary of the PrimeWest Health Model of Care for our Special Needs Plan members. It provides a general overview of the Model of Care.