Quality Improvement & External Quality Review

APS as External Quality Review Organization

APS is designated by the Centers for Medicare and Medicaid Services (CMS) as a QIO-like organization, allowing states to receive a 75% matching reimbursement.

To ensure that Medicaid recipients receive high quality, appropriate care, agencies need to engage independent external quality review organizations (EQROs) to assess the performance of their managed care entities.

Leveraging our extensive national experience and drawing on our depth of clinical expertise, APS helps states meet the EQRO requirement with comprehensive services that monitor quality of care, finances, encounter data, access and provider networks, and grievances, with the goal of:

improving health outcomes
increasing consumer satisfaction
delivering care that is accessible, coordinated, and of high quality

Customizable, comprehensive and collaborative, APS EQRO programs are designed to help you successfully meet your goals.

Customizable

Our EQRO services can be tailored to apply to unique needs To assist states and counties in measuring and improving services, processes and outcomes,.

Information system capability assessments
HEDIS reviews and program analysis
Performance measure validations, improvement plan development, implementation and review
Ongoing training, education and technical assistance during and after reviews
Medical education interventions for facilities, physicians and other providers
Comprehensive data collection, analysis and reporting
Continuous quality improvement and outcomes management

Comprehensive

APS’ medical and behavioral expertise informs our ability to conduct effective and superior quality reviews through thorough assessments of Medicaid programs and MCOs, including HMOs, senior care organizations, behavioral health organizations, and other health plans providing healthcare coverage to Medicaid recipients.

Collaborative

By monitoring performance standards and providing actionable feedback, education, and recommendations, we work with states and counties to make improvements that improve health and increase consumer satisfaction.

Program performance benchmarking
Best practice identification
Healthcare delivery system improvement

Results
Contributed to a significant “culture” shift and collaboration and data driven decision-making through analysis and circulation of local mental health data.
California External Quality Review Organization for Mental Health Plans

Launched a website to provide EQRO-specific resources and other useful information to managed care plans and other stakeholders
California External Quality Review Organization for Mental Health Plans

Improved stakeholder satisfaction by streamlining EQR processes and reports
Massachusetts External Quality Review Organization

Provided and publicized data on State and County-specific disparities in healthcare services to stimulate performance improvement activities
California External Quality Review Organization for Mental Health Plans

Testimonials

"In reviewing your thoughtful report we have found valuable areas in which to focus our attention and in which to continue to improve the quality and effectiveness of mental health services in Los Angeles County. We thank you again for the opportunity to respond to this report and appreciate having a collaborative approach to this process."
— Marvin Southard, Director of Mental Health, Department of Mental Health,
Los Angeles County

"We really appreciated the whole supportive approach you all have taken and feel the feedback here has been and will continue to be very helpful for us in numerous arenas. In these times of economic pressure, the kind of accountability you help us to achieve is more and more important."
— Leslie Tremaine, Ed.D. Santa Cruz County Mental Health Director