Washington Medicaid projects and activities

External quality review activities

Web pages for Washington MCOs and RSNs (All-Plan Meetings, RSN PIPs, contact information)

As Washington’s Medicaid External Quality Review Organization (EQRO) since 1994, Acumentra Health performs federally mandated and optional EQR-related activities to support quality improvement in the Medicaid program. These activities involve review of managed medical services delivered by managed care organizations (MCOs) and of managed mental health services delivered by Regional Service Networks (RSNs).

Mandatory activities include

• reviewing RSN compliance with regulatory and contractual provisions governing managed care (mental health only)
• validating RSNs’ performance improvement projects (PIPs—mental health only)
• validating performance measures. For physical health, Acumentra Health annually collects, audits, and reports on the MCOs’ HEDIS^® measures. For mental health, Acumentra Health validates statewide measures used to compare RSN performance; this activity includes audits of RSN information systems.

Optional activities include

• conducting annual CAHPS^® surveys of consumer satisfaction with the medical services provided by MCOs
• performing encounter data validation (mental health only)
• performing a study of the quality of mental health services delivered by RSNs

Washington State Collaborative

Acumentra Health is the contractor for the Collaborative and conducts learning tracks that focus on child health in partnership with the University of Washington.

This shared learning project is part of a multi-year effort to improve health care for Washingtonians with chronic diseases. The goal is to make it easier for clinics throughout the state to manage care for patients with chronic conditions and to engage patients in taking an active part in their own treatment plans. More than 150 healthcare facilities across Washington have participated in at least one state collaborative since 1999. The current learning tracks focus on adult and child asthma, adult hypertension and diabetes, childhood obesity prevention and management, and establishing a medical home for children.

In 2009, Pediatrics published an article by Collaborative faculty members describing their work on a chronic care approach to obesity prevention and management.
Download Pediatrics article by Collaborative faculty (PDF)

Washington State Collaborative website