Medicare Advantage Quality Strategy

In early 2010, the Centers for Medicare & Medicaid Services (CMS) developed a Quality Improvement Strategy for the Medicare Advantage (MA) and Prescription Drug Plan (PDP) Programs based on the Institute of Medicine (IOM) report from 2001 and the Triple Aim. This strategy was expanded in 2011 to reflect the Department of Health and Human Services’ (HHS) National Strategy for Quality Improvement in Health Care, referred to as the National Quality Strategy (NQS), and the National Prevention Strategy (NPS) that were developed in accordance with the Affordable Care Act (ACA).

The final MA and PDP Quality Strategy was released in June 2012, entitled “Medicare Advantage and Prescription Drug Plan Quality Strategy: A Framework for Improving Care for Beneficiaries.” The full report is available below.

This report is the culmination of a coordinated staff effort and leadership across CMS working on quality. CMS intends for this Quality Strategy to serve as a framework to advance our continuous QI efforts and to establish a culture of improving quality of care and services in the MA and PDP programs.

The overall goal of our MA and PDP Quality Strategy is to improve the quality of care for Medicare beneficiaries enrolled in these programs. The foundation of this strategy and the quality improvement (QI) program is improving care coordination and providing health care using evidence-based clinical protocols. All Medicare Advantage Organizations (MAOs) are required, as a condition of their contract with CMS, to develop a QI program that is based on care coordination for enrollees. The MA and PDP Quality Strategy is designed to strengthen this requirement by providing a framework for MAOs and PDPs to improve care, services, and patient health outcomes.