CESSNA 177 — Performance

The document outlines the methodology for the SFY 2026 Cardinal Care Performance Withhold Program (PWP) as established by the Virginia Department of Medical Assistance Services (DMAS). It details the scoring mechanism for managed care organizations (MCOs) based on various healthcare performance measures. The PWP evaluates MCO performance on multiple National Committee for Quality Assurance (NCQA) measures, including HEDIS and CMS Core Set measures. The document serves as a guide for MCOs to understand how their performance will be assessed and how they can earn back withheld funds based on their scores. It also indicates future expansions of the measure set and provides a comprehensive overview of data collection and scoring methods.

• MCOs will be evaluated on 10 performance domains for the SFY 2026 PWP.
• Only measures with a 'Reportable' audit result will be included in scoring.
• Performance scores are based on comparisons to national percentiles for each measure.
• Future expansions of the measure set will include behavioral health indicators.