Performance Measures and Encounter Data Validation

Physical Health and Behavioral Health Organization Performance Measure Validation

Health Services Advisory Group (HSAG), the Department of Health Care Policy & Financing's External Quality Review Organization (EQRO), conducts validation activities outlined in the CMS Performance Measure Validation Protocol for Physical Health and each of the Behavioral Health Organizations (BHOs). The performance measures are calculated on an annual basis. Each BHO is subject to the same measures making it possible to compare performance measures for each health plan.

Regional Accountable Entities (RAEs)

2023

• Rocky Mountain Health Plans (Region 1)
• Northeast Health Partners (Region 2)
• Colorado Access (Region 3)
• Health Colorado, Inc. (Region 4)
• Colorado Access (Region 5)
• Colorado Community Health Alliance (Region 6)
• Colorado Community Health Alliance (Region 7)

2022

• Rocky Mountain Health Plans (Region 1)
• Northeast Health Partners (Region 2)
• Colorado Access (Region 3)
• Health Colorado, Inc. (Region 4)
• Colorado Access (Region 5)
• Colorado Community Health Alliance (Region 6)
• Colorado Community Health Alliance (Region 7)

2021

• Rocky Mountain Health Plans (Region 1)
• Northeast Health Partners (Region 2)
• Colorado Access (Region 3)
• Health Colorado, Inc. (Region 4)
• Colorado Access (Region 5)
• Colorado Community Health Alliance (Region 6)
• Colorado Community Health Alliance (Region 7)

2020

• Rocky Mountain Health Plans (Region 1)
• Northeast Health Partners (Region 2)
• Colorado Access (Region 3)
• Health Colorado, Inc. (Region 4)
• Colorado Access (Region 5)
• Colorado Community Health Alliance (Region 6)
• Colorado Community Health Alliance (Region 7)

Physical Health Care Performance Measure Validation

2022

• Aggregate Report
• Denver Heath Medical Plan
• Rocky Mountain Health Plans

2021

• Aggregate Report
• Denver Health Medical Plan
• Rocky Mountain Health Plans

2020

• Aggregate Report
• Denver Health Medical Plan
• Rocky Mountain Health Plans

2019

• Aggregate Report
• Denver Health Medicaid Choice
• Rocky Mountain Health Plans

2018

• Aggregate Report
• Access Kaiser Permanente
• Denver Health Medicaid Choice
• Rocky Mountain Health Plans

2017

• Aggregate Report
• Access Kaiser Permanente
• Denver Health Medicaid Choice
• Rocky Mountain Health Plans

2016

• Fee-for-Service Population
• Aggregate Report
• Rocky Mountain Health Plans
• Denver Health Medicaid Choice

Access Behavioral Care Performance Measure Validation

• 2019
• 2018
• 2017
• 2016

Behavioral HealthCare Inc. Performance Measure Validation

• 2019
• 2018
• 2017
• 2016

Colorado Health Partnerships

• 2019
• 2018
• 2017
• 2016

Foothills Behavioral Health Partners

• 2019
• 2018
• 2017
• 2016

BHO-HCPF Annual Performance Measures Scope Documents

2015

Access Behavioral Care Northeast

• 2019
• 2018
• 2017
• 2016

CHP+ State Managed Care Network (SMCN) Claims Audit

• 2020
• 2019
• 2018
• 2017
• 2016