Acumentra Health Wins Bid to Perform External Quality Review of Washington's Medicaid Managed Care Program
Posted on: Tuesday, 4 December 2007, 15:00 CST
Acumentra Health announced today that the Washington State Department of Social & Health Services (DSHS) has chosen the organization to perform outside review of the managed care health services provided to Medicaid enrollees. The new contract will span from 2008 through 2010.
Federal law requires an annual external quality review (EQR) of state programs that deliver Medicaid services through managed care. Acumentra Health has served as the EQR contractor for medical services overseen by DSHS's Health and Recovery Services Administration (HRSA) since 1994.
The contract renews and expands Acumentra Health's role. The organization will also review managed mental health care services overseen by DSHS's Mental Health Division (MHD). Acumentra Health performs similar duties under contract with Oregon's state Medicaid oversight agencies.
"Acumentra Health looks forward to continuing to partner with DSHS to improve the quality of medical care for Washington's Medicaid enrollees," said Jon Mitchell, FACHE, president and chief executive officer of Acumentra Health. "We're also excited about the opportunity to join with MHD to promote the delivery of high-quality mental health services. We believe our expertise will greatly enhance the state of Washington's move toward integrating the delivery of medical and mental health care."
DSHS contracts with 20 managed care plans to provide medical and mental health services for Medicaid enrollees throughout the state. Currently, these health plans serve approximately 1 million Medicaid enrollees.
Under the new contract, Acumentra Health will conduct review activities required by federal rules that specify how the state is to ensure that managed care plans deliver high-quality care to Medicaid enrollees. Primary activities are:
Performance measurement and reporting activities for the Division of Healthcare Services, including
-- conducting and reporting on the annual HEDIS® measures of clinical services provided by Washington health plans and the annual CAHPS® surveys of health plan enrollee satisfaction
-- validating the standard performance measures the state uses to monitor the health plans' delivery of medical and mental health services
External quality review of the managed care plans that deliver mental health services to Medicaid enrollees, including
-- compliance review to determine whether the plans are meeting federal standards for enrollee access to health care, structure and operation of managed care plans, and quality measurement and improvement
-- evaluation of the health plans' performance improvement projects aimed at improving clinical outcomes and service delivery
-- assessment of state and health plan information systems and the quality of the administrative data used by the state to monitor performance
Evaluation of the state's Foster Care Integration Pilot Project. Scheduled to begin in mid-2008, this project has the goal of establishing a medical home for one-stop coordinated care for this vulnerable population of children
Coordination of the Children's Health Improvement Collaborative: This state-funded project, now in its fourth year, aims to help local clinics adopt and use best practices in delivering care for low-income children; focus topics include asthma care, overweight prevention, and establishing a medical home
Acumentra Health will synthesize the review results for all Medicaid plans in an annual report each year and will provide Web-based communications to keep stakeholders informed at all stages throughout the contract period.
Acumentra Health is a nonprofit organization dedicated to improving the quality and effectiveness of health care. Established in 1984, Acumentra Health's work spans the continuum of care, reaching all ages and economic levels, and all delivery settings. Acumentra Health contracts with Oregon and Washington to provide External Quality Review (EQR) of managed care health services provided to Medicaid enrollees, as well as with Medicare to support effective, evidence-based health care for Medicare beneficiaries in Oregon along with overseeing the state's Medicare Beneficiary Protection Program. In addition, Acumentra Health contracts with state agencies, public health organizations and coalitions, health plans, hospitals, physicians and others to conduct healthcare quality assurance and quality improvement projects. As a leader in healthcare quality, Acumentra Health provides expertise in areas such as performance measurement and improvement, surveys, utilization management, healthcare data analysis, chronic disease management, peer review, and electronic health records. For more information, visit http://www.acumentra.org.
HEDIS is a registered trademark of the National Committee for Quality Assurance.
CAHPS is a registered trademark of the Agency for Healthcare Research and Quality.
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Source: Business Wire
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