External quality review

Acumentra Health holds external quality review (EQR) contracts for state Medicaid agencies in Oregon and Washington. Our staff has expertise and experience in

• Medicaid programs and population characteristics, policies, data systems, and processes
• managed care delivery systems, organizations, and financing
• quality assessment and improvement methods
• research design and methodology, including statistical analysis
• assessing program services for quality, timeliness, and access
• validating encounter data; making recommendations to address opportunities for improvement
• evaluating the effectiveness of programs, policies, and interventions
• conducting contractual compliance and regulatory reviews for managed care organizations (MCOs) and prepaid inpatient health plans (PIHPs)
• performing information systems capabilities assessments for states and MCOs/PIHPs

EQR-related activities

Acumentra Health’s experts assist states in designing and conducting EQR-related activities and programs that meet CMS requirements. Acumentra Health provides all federally mandated and optional EQR-related activities, as well as complementary services.

• validating or conducting performance improvement projects
• validating or calculating performance measures
• performing encounter data validation
• validating or administering consumer or provider surveys
• evaluating, designing, and conducting focused quality of care studies
• conducting individual case review
• evaluating states’ federally mandated Medicaid Quality Assessment and Performance Improvement Strategy
• providing technical assistance to states, MCOs, and PIHPs
• designing and developing requests for proposals for EQR and EQR-related services