AUTO ASSIGNMENT ALGORITHM FOR QUEST INTEGRATION (QI) MEMBERS
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Governs how QI members are automatically assigned to QUEST Integration health plans and how auto-assign percentages are calculated and allocated among available plans for calendar year 2027 (and transitional years referenced); affects QUEST Integration health plans operating in Hawaii.
This memorandum is an addendum to QI-2207 and inserts updated guidance and tables through CY2027, including selected quality measures and allocation percentages.
Auto-assignment Calculation Criteria
Auto-assign calculation criteria
Algorithm components and yearly parameters used to compute auto-assignment distributions among health plans.
Performance Measures and Scoring Format
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Auto-assignment Allocation and Ranking Instructions
Auto‑assignment allocation and ranking — plans ranked, allocations assigned, rounding and reduced‑plan scenarios
Health plans are ranked per measure and given an overall rank that determines how much of the quality portion of the auto‑assign allocation each plan receives; when totals are not whole numbers, percentages may be rounded (generally favoring the highest‑ranking plan). If fewer than five plans are available (enrollment caps or unavailable), pre‑specified distributions for four‑ or three‑plan scenarios apply. The auto‑assign algorithm sums ordinal ranks across the four measures (lowest total = best) and uses Table 3 to assign the quality allocation by overall rank; tied plans receive the same rank and the next rank is skipped, and MQD may update allocations or the quality portion over time.
- Each Health Plan receives an ordinal rank (1 highest) on each of the four measures; equal scores yield equal ranks and the next rank is skipped.
- Overall rank = sum of ranks across four measures; lowest total is ranked highest overall and determines quality allocation per Table 3.
- Table 3 specifies allocations by rank for five-, four-, and three‑plan scenarios (e.g., with five plans: Rank 1 = 40%, Rank 2 = 30%, Rank 3 = 15% or 20% depending on scenario, etc.).
- If allocated totals are not whole numbers, percentages may be rounded up or down, generally favoring the highest‑ranking plan; the rounded totals are used to configure the auto‑assign algorithm.
- If one or more plans are enrollment capped or unavailable, distributions for four‑ or three‑plan scenarios in Table 3 are used.
- MQD reserves the right to update allocations or change the quality portion applied based on strategic priorities or performance changes.
Key Terms and Allocation Components
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