Schemes or plans that examine and seek to achieve enhancement in major areas of clinical and nonclinical services. These plans are usually based on utilization, diagnosis, and outcome information; data from surveys; and grievance and appeals processes. They measure performance at two periods of time to find out if improvement has occurred. These projects are required by the state and can be of the managed care organizations’/prepaid health plans’ (MCOs’/PHPs’) choosing or prescribed by the state.