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External Quality Review

HealthInsight Oregon performs federally mandated external quality review (EQR) 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.

Our staff has expertise and experience in

  • 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

EQR-related activities

HealthInsight Oregon’s experts help states design and conduct activities and programs that meet federal EQR requirements. We conduct all federally mandated and optional EQR-related activities, as well as complementary services.
  • validating and conducting performance improvement projects
  • monitoring managed care plans' 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 Assessment and Performance Improvement Strategies