Playing a crucial role in Medicaid managed care quality and accountability is the External Quality Review (EQR). Part of a suite of tools such as EQR Protocols, Quality Strategy, Quality Assessment and Performance Improvement (QAPI) requirements, and State Directed Payments, EQR helps states drive quality improvement through managed care plans.
Qsource serves as an independent external quality review organization (EQRO) for Medicaid programs and Children’s Health Insurance Programs (CHIPs). We evaluate the quality, timeliness and accessibility of services provided to the adults and children receiving managed care through Medicaid and CHIP health plans, and dual-eligible special needs plans (D-SNPs).
Our EQRO Division:
- Assesses contractual and regulatory compliance requirements
- Formulates study and sampling methods
- Develops audit and data collection tools
- Performs data aggregation and statistical analyses
- Conducts quality improvement (QI) activities.
With an in-depth knowledge of managed care systems, the Qsource EQRO Division meets EQR challenges with:
- Clinical QI Specialists
- Healthcare Data Analysts
- Call-Center Staff and Technical Writers