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iCare Quality & HEDIS 5 Star and P4P Programs

Quality Initiatives

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Did you know...


iCare Medicaid has received two esteemed accreditations from the National Committee of Quality Assurance (NCQA). 



NCQA is a private, non-profit organization dedicated to improving health care quality.


The Health Equity Accreditation is a nationally recognized accreditation that purchasers, regulators, and members can use to distinguish organizations that meet rigorous standards in the delivery of culturally appropriate and quality improvement interventions for diverse populations.

The Health Plan Accreditation is a nationally recognized accreditation that provides a framework for best practices, aligns with state requirements, and supports high-impact wellness standards in the delivery of services focused on member protection and quality improvement.


To learn more about NCQA and its efforts to improve the quality of healthcare, visit:



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 uses HEDIS specifications for all of the P4P measures.  


5-Star Measures for Current Measure Year


Click below to see the current quality measures for CMS Five Star Quality Program for Medicare Advantage Plans.


CMS Part C and Part D 5-Star Rating Measures



Did you know...

That iCare conducts provider access surveys?

Provider Access Survey Results



P4P Measures for Current Measure Year


Click below to see the quality measures, metrics, and weights for the current Measure Year (MY) for Medicaid Pay-for-Performance (P4P) Program.


MY2024 SSI & BadgerCare P4P Quality Metrics


MY2024 SSI & BadgerCare P4P Measures and Weights


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 Mark Clausen, Cognisight Account Manager at 585-662-4290 or Amanda Harcus,  Director of Market Development at



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