Managed Care Organizations · Measurement & Outcomes · 5 min read
What outcomes should managed care organizations (MCOs) measure for RHTP funding?
RHTP rewards measurable improvement, so managed care organizations (MCOs) should track HEDIS quality measures for rural members, ED and inpatient utilization, member engagement and retention, and health-related social needs screening and resolution. Building these metrics in from the start is what separates a fundable, renewable program from a one-time pilot.
Why measurement is non-negotiable
CMS built measurability into the allowable uses, so states pass that expectation to sub-recipients. For managed care organizations (MCOs), a credible measurement plan is part of the eligibility story, not an afterthought.
Metrics that matter
The most defensible metrics for managed care organizations (MCOs) include:
- HEDIS quality measures for rural members
- ED and inpatient utilization
- member engagement and retention
- health-related social needs screening and resolution
Turning metrics into renewals
With $10 billion flowing each year through FY2030, programs that report clean outcome data are best positioned for continued state support. Misalignment between RHTP-funded services and the plan's value-based incentives can create duplicate or stranded programs.
Frequently asked questions
- Does RHTP require managed care organizations (MCOs) to report outcomes?
- States are accountable to CMS for outcomes and pass reporting expectations to their sub-recipients, so yes, in practice.
- How soon should measurement start?
- From day one. Retrofitting measurement after launch weakens both the funding case and the results.
Figures reflect the CMS Rural Health Transformation Program NOFO and the December 2025 award announcement. RHTP Tracker is an independent resource by Moodr Health and is not affiliated with CMS.