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iCare Quality & HEDIS 5 Star and P4P Programs

Quality & HEDIS 5 Star and P4P Programs

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In early 2008, the Centers for Medicare & Medicaid Services (CMS) contracted with the National Committee for Quality Assurance (NCQA) to develop a strategy to evaluate the quality of care provided by Medicare Advantage Special Needs Plans (SNPs). This strategy relies on a phased approach, beginning with defining and assessing desirable structural characteristics and followed by assessing processes and, eventually, outcomes. The evaluation approach includes several types of assessments.

  • HEDIS® measures
  • CAHPS measures
  • HOS measures
  • CMS specific measures
  • Measures that evaluate structure and process requirements through submission of documentation


The State of Wisconsin has a similar program to CMS to evaluate the quality of care provided by Medicaid Plans.  The goal of this program is to improve the quality of care received by BadgerCare Plus and Medicaid SSI members.  The Pay-for-Performance (P4P) Program includes a combination of HEDIS and HEDIS-like and other measures chosen by the State of Wisconsin.  NCQA’s Quality Compass Results will be used to set the Level Targets for HEDIS measures and other statewide results for non-HEDIS measures.


Objectives of CMS's SNP Assessment Program


  • Evaluate the quality of care SNPs provide to their beneficiaries
  • Evaluate how SNPs address the special needs of their beneficiaries
  • Provide data to CMS to allow plan-to-plan and year-to-year comparisons



Focus of DHS Quality Measures

  • Preventive care
  • Up-to-date interventions/treatments for acute episodes of illness
  • Chronic disease management
  • Appropriate medication reconciliation/treatment
  • Other measures – including but not limited to: Lead Screening, Health Check, Potentially Preventable Readmission


Did you know...

...that iCare conducts Provider Satisfaction Surveys? 

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iCare Performance Measures Calendar

Five Star and P4P Measures for MY2019


The documents below show the current quality measures for CMS Five Star Quality Program for Medicare Advantage Plans and the Medicaid Pay-for-Performance Plans.


2019 BadgerCare Plus P4P Measures  2019 SSI P4P Measures  


2019 Part-C 5-Star Measures  2019 Part-D 5-Star Measures





Independent Care Health Plan’s Annual Diagnoses Collection and Confirmation Project


As part of Independent Care Health Plan ’s contract with The Centers for Medicare & Medicaid Services (CMS), it is required to compile and report diagnostic profiles annually. This information must be obtained via a medical record review of individual member diagnoses that were treated or impacted within a claim (calendar) year.

Independent Care Health Plan has partnered with Cognisight to perform the annual collection of data and confirmation project. Cognisight’s goal is to obtain a “complete diagnostic member profile,” while attempting to minimize disruptions to your office workflow and staff.

CMS will only accept submission of diagnoses when they are listed on an encounter note rather than on an active problem list, signed lab result or consult. This does not imply that a provider’s documentation for the purposes of patient care is not sufficient, only that CMS has specific requirements to recognize existing diagnoses for a patient.

This information is time-sensitive and a response is needed as soon as possible.

If you have additional questions, please contact Jane Brownyard, Director of Account Management, at Cognisight at 585-662-4285 or Don Slowik at



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