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.
Annual Technical Report (ATR)
This report is the External Quality Review Organization's (EQRO) assessment of State and Federally mandated activities related to the unifying framework: structure, process, and outcomes. This framework serves as the foundation for the EQRO'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).
Consumer Assessment of Healthcare Providers and Systems (CAHPS®)1 Survey
Medicare Advantage Prescription Drug Plan (MA-PD) CAHPS Survey
The CAHPS Survey measures members' satisfaction with their care in areas such as claims processing, customer service, and getting needed care quickly.
Health Outcomes Survey (HOS)
The HOS is an important part of the Centers for Medicare & Medicaid Services’ (CMS) quality improvement activities. The survey is administered by the National Committee for Quality Assurance (NCQA) in partnership with CMS. The survey is administered to a random sample of 1,200 members from each Medicare Advantage Organization (MAO) at the beginning (baseline survey) and end (follow-up survey) of a two-year period. Aged and disabled beneficiaries enrolled in an MAO are eligible for sampling. A new baseline sample is surveyed annually. For each member who completes a baseline and follow-up survey, a two-year change score is calculated and the member’s physical and mental health status are categorized as better, the same, or worse than expected, taking into account risk adjustment factors. Section 722 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 mandates the collection, analysis, and reporting of health outcomes information. This survey is the only patient-reported outcomes measure in Medicare managed care and remains a critical part of assessing health plan quality.
Quality Improvement Progress Report
This report is for our providers and partners and covers quality initiatives as well as member outcomes from the past year.
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.
Health Record Reviews/Site Visit Reports
PrimeWest Health performs regular Health Record Reviews and Site Visits at provider locations. These reports provide the results of the completed audits and site visits.
Quality Assurance Plan
This document presents the written Quality Assurance Plan and describes the PrimeWest Health Quality program. Our Quality Assurance Plan was developed in accordance with State and Federal requirements as well as National Committee for Quality Assurance (NCQA) standards.
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.
1CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)