Acumentra Health Signs Contract to Perform External Quality Review of Oregon’s Medicaid Managed Care Program

Acumentra Health announced today it has signed a contract with the Oregon Department of Human Services, Division of Medical Assistance Programs (DMAP), to perform outside review of the medical and dental services provided to Oregon Health Plan (OHP) enrollees. Federal law requires an annual external quality review (EQR) of state programs such as OHP that deliver Medicaid services through managed care.

The EQR contract spans two years ending in March 2009. Acumentra Health previously served as DMAP’s EQR contractor from 2003 through 2005 and has performed similar duties under contract with the OHP managed mental health care program since 2004.

Acumentra Health will conduct specific review activities required by federal rules that specify how states are to ensure managed care organizations (MCOs) deliver high-quality health care to Medicaid enrollees. The contract covers three primary activities:

Compliance review: determine whether the MCOs are meeting federal standards for enrollee access to health care, structure and operation of managed care plans, and quality measurement and improvement

PIP validation: determine whether the MCOs are conducting valid performance improvement projects (PIPs) aimed at improving clinical outcomes and service delivery

Performance measure validation: assess whether the state has in place valid measures of MCO performance and whether the MCOs are submitting valid data to enable DMAP to measure their performance

Acumentra Health will report to DMAP on each separate activity and will synthesize the review results for all MCOs in an annual report each year.

Currently, DMAP contracts with 22 MCOs to provide medical, dental, and chemical dependency services to OHP enrollees throughout Oregon. As of January 2007, nearly 361,000 Oregonians were eligible to be enrolled for these services. Separately, under its contract with the state Addictions and Mental Health Division, Acumentra Health reviews the operations of nine MCOs that provide managed mental health care to OHP enrollees.

“Acumentra Health, as Oregon’s federally designated Quality Improvement Organization, is most enthusiastic about this opportunity to work with the Division of Medical Assistance Programs to enhance the quality of medical and dental services provided to Oregon Health Plan members,” said Jon Mitchell, president and chief executive officer of Acumentra Health.

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 Medicare to support effective, evidence-based health care for Medicare beneficiaries in Oregon and oversees 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 and electronic health records. For more information, visit http://www.acumentra.org.