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External Quality Review

In 2017 HealthInsight Management Corporation created HealthInsight Assure, LLC, to provide independent direction and governance of the company's external quality review (EQR) and other health care quality assurance services in New Mexico and Oregon.

HealthInsight Assure performs federally mandated external quality review for state Medicaid agencies, providing analysis and recommendations to help the states transform their managed care delivery systems. We identify strengths and improvement needs in the system as a whole, and within individual managed care plans that serve the Medicaid population.

We also perform quality reviews for some of New Mexico’s most vulnerable populations, which helps state agencies to monitor health care delivery. One example of this work with the New Mexico Corrections Department, in which we review medical records to gather data on the quality of care that inmates in our prison system receive when they need it.

Staff Expertise

  • Medicaid programs and population characteristics, policies and data systems
  • Managed care delivery systems, organizations and financing
  • Evaluating program effectiveness in terms of service quality, timeliness and access
  • Quality assessment and performance improvement methods
  • Research design and methodology, including statistical analysis


HealthInsight Assure’s experts help state agencies design and conduct activities and programs that meet federal external quality review requirements. We conduct all federally mandated and optional EQR-related activities, as well as complementary services:
  • Assessing the validity and reliability of performance improvement projects
  • Monitoring managed care plan compliance with federal and state regulatory and contractual standards
  • Validating and calculating performance measures
  • Validating the accuracy and completeness of Medicaid encounter data
  • Assessing information system capabilities for state agencies and managed care plans
  • Validating and administering consumer and provider surveys
  • Designing and conducting focused quality of care studies
  • Evaluating states' federally mandated Medicaid Quality and Performance Improvement strategies
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