Pennsylvania Statutes Title 62 P.S. Poor Persons and Public Welfare § 532-A. Managed care organization performance reporting

(1) Conduct ongoing analyses of existing and relevant State claims databases to identify instances of potentially avoidable admissions, readmissions and emergency visits with potential excess expenditures associated with the cases.

(2) Create or locate Statewide norms for admissions, readmissions and emergency visits.

(3) Measure actual-to-expected managed care organization performance compared to Statewide norms.

(4) Compare managed care organizations with the managed care organizations' peers using risk adjustment procedures that account for the chronic illness burden of each plan's enrollees.

(5) Distribute reports to managed care organizations to provide the managed care organizations with actionable information to create policies, contracts and programs designed to improve target outcomes.