Program Resources for Primary Care Providers
2027 Quality Program Guide
The Program Guide for the 2027 Quality Program is linked below. The Program Guide is also available through HHIN+ under the Quick Links menu. The Program Guide provides an overview of program eligibility, payment and scoring methodologies, measure specifications, and other important program requirements. We encourage providers to review the guide carefully and utilize the available tools and resources throughout the year to support success in the program.
Provider Resource Guides
2027 Quality Program - Provider Resource Guides [PDF] - Coming Soon
Stars Medicare Quality Measures – Code Sets
- Breast Cancer Screening [PDF]
- Care for Older Adults – Functional Status Assessment [PDF]
- Care for Older Adults – Medication Review [PDF]
- Colorectal Cancer Screening [PDF]
- Concurrent Use of Opioids and Benzodiazepines [PDF]
- Controlling High Blood Pressure [PDF]
- Depression Screening and Follow-Up for Adolescents and Adults – Follow-Up on Positive Screen [PDF]
- Eye Exam for Patients with Diabetes [PDF]
- Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions [PDF]
- Glycemic Status Assessment for Patients With Diabetes (≤9.0%) [PDF]
- Kidney Health Evaluation for Patients With Diabetes [PDF]
- Medication Adherence for Cholesterol (Statins) [PDF]
- Medication Adherence for Diabetes [PDF]
- Medication Adherence for Hypertension (RAS Antagonist) [PDF]
- Osteoporosis Management in Women Who Had a Fracture [PDF]
- Plan All-Cause Readmissions [PDF]
- Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults [PDF]
- Statin Use for Patients With Diabetes [PDF]
- Transitions of Care: Patient Engagement After Inpatient Discharge [PDF]
- Transitions of Care: Medication Reconciliation Post-Discharge [PDF]
Commercial & QUEST Quality Measures – Code Sets
- Child and Adolescent Well-Care Visits [PDF]
- Childhood Immunization Status [PDF]
- Controlling High Blood Pressure [PDF]
- Glycemic Status Assessment for Patients With Diabetes (<8.0%) [PDF]
- Screening for Depression and Follow-Up Plan [PDF]
- Well-Child Visits in the First 30 Months of Life (15 Months and 30 Months) [PDF]
Scorecard and Care Gap Reports
Please see the resources for a step-by-step explanation of how to utilize the scorecard and care gap reports and how to access them.
Measures Specifications and Program Incentive Infrastructure
Please see the recorded webinar for an explanation of the measure specifications and program incentive infrastructure.
Additional Resources
- Closing Care Gaps with Alternative Visits 2027 [PDF] - Coming Soon
Request for Review Process
Pay-to entities who participate in the 2027 Quality Program may utilize the Review Request form for the following reasons:
- To submit a supplemental data request with supporting medical record evidence to close a care gap (as aligned with measure specifications);
- To submit an exclusion request with supporting medical record evidence to remove a member from a denominator (as aligned with measure specifications);
- To seek a review of their numerator score and/or payment in the Performance Measures; and
- To seek an exception from an aspect of the program.
Email the form and supporting documentation to PSinquiries@hmsa.com. You may also fax the form and supporting documentation to 808-948-5680 or mail them to:
HMSA
6-QM
ATTN: Quality Management
PO Box 860
Honolulu, HI 96808
- 2027 Quality Program – Request for Review Form [PDF] - Coming Soon