Plan Performance Report 2025

Quality Rating System (QRS): Delivery System & Payment Strategies Domain

The Quality Rating System (QRS) is used by Covered California to assess and improve the performance of Qualified Health Plans (QHPs) offered through Exchanges. It evaluates healthcare quality and plan administration for enrollees based on network types (HMO, PPO, EPO). Covered California collaborates with contractors to refine measurement standards, enhance data sharing, and support population health management, clinical care, and cost efficiency. QRS results are reported for 12 health plan products that meet CMS participation criteria.