Performance Measure Validation

PMV is designed to assess the accuracy of reported performance measures and determine the extent to which the reported rates follow the measure specifications and reporting requirements. The validation of performance measures is one of the mandatory EQR activities that the state Medicaid agencies are required to perform as described in CFR §438.358(b)(2).

In accordance with CMS’ EQR Protocol 2, OHA contracted HSAG to evaluate the accuracy and validity of OHA’s calculation of the performance measure rates for the 16 coordinated care organizations (CCOs). OHA identifies the incentive performance measures for validation while CMS’ EQR Protocol 2 identifies key types of data that should be reviewed as part of the validation process. The following list describes the type of data collected and how HSAG analyzes the data:

• Information Systems Capabilities Assessment (ISCA): OHA completes and submits an ISCA for HSAG’s review and uses the responses from the ISCA to complete the pre-site visit assessment of OHA's information systems.
  
  
• Source code (programming language) for performance measures: OHA calculates the performance indicators using source code and is required to submit the source code used to generate each performance measure being validated.
  
  
• Primary Source Verification (PSV) of performance measures: PSV is a review technique used to confirm that the information from the primary data source matches the output information used for reporting.
  
  
• Supporting documentation: HSAG requests documentation that would provide reviewers with additional information to complete the validation process, including policies and procedures, file layouts, system flow diagrams, system log files, and data collection process descriptions.

In addition to document review, HSAG conducts an site visit audit, virtual or in-person, to collect information through interviews, system demonstrations, review of data output files, PSV, observation of data processing, and review of data reports. HSAG reviews all supporting documentation, identifying issues or areas needing clarification for further follow-up.

The following table highlights the performance measures evaluated by HSAG:

For questions related to the Performance Measure Validation activity, please contact:

       Kristina Dabney, MBA, ARRT RT(R)(M)
       Auditor I, Data Science & Advanced Analytics
       Telephone: 602.432.2257
       Email: kdabney@hsag.com