External Quality Review (EQR)

HSAG is nationally recognized as an external quality review organization (EQRO) that evaluates managed care organizations (MCOs) and prepaid inpatient health plans (PIHPs) as required by the Balanced Budget Act of 1997, and whose quality review services affect more than 13 million Medicaid recipients, approximately 45 percent of the nation's Medicaid population. HSAG has extensive experience with Medicaid programs in more than a dozen states analyzing and evaluating aggregated information on timeliness, access, and quality of health care services furnished to Medicaid enrollees by each MCO.

Compliance Monitoring Review

The federal managed care regulations require that a state, or its designee, conduct a review to determine the managed care organizations’ (MCOs’) and prepaid inpatient health plans’ (PIHPs’) compliance with Medicaid managed care standards and state contracts. Oversight activities must focus on evaluating quality outcomes and the timeliness of, and access to, care and services provided to Medicaid beneficiaries by the MCO/PIHP. As an external quality review organization (EQRO), HSAG either performs or evaluates the on-site compliance audit process for each contracted state, ensuring that the review process is in alignment with federal regulations.

Performance Measure Validation

HSAG performs performance measure validation as part of our EQR services. The Balanced Budget Act of 1997 (BBA) requires that performance measures reported or calculated by state Medicaid agencies be validated for managed care organizations (MCOs) or prepaid inpatient health plans (PIHPs).

Performance Improvement Projects (PIPs)

HSAG has more than 10 years of experience reviewing, validating, and evaluating performance improvement projects (PIPs). Since 1997, HSAG has successfully validated hundreds of different PIPs conducted by a variety of managed care organizations (MCOs), prepaid inpatient health plans (PIHPs), behavioral health organizations (BHOs), and other managed care entities. In addition, HSAG has developed and facilitated a variety of statewide collaborative PIPs, targeting specific areas for improvement that are high priorities for state Medicaid agencies. HSAG’s exposure to this variety of topics and health plan models provides it with extensive experience to develop, structure, and conduct successful PIPs that bring about true, sustained quality improvement.

Encounter Data Validation

Coming Soon!

Focused Studies

Coming Soon!

Information Systems Assessment/Readiness Reviews

HSAG has more than nine years of experience conducting readiness reviews and auditing health care provider information systems at the managed care organization (MCO) level, individual provider level, and state agency level. These reviews ensure that plans have the system capacity needed to enroll recipients in expanded service areas and accommodate anticipated increases in enrollment.

HEDIS Analysis Reports

Coming Soon!

HEDIS Audits

HSAG offers HEDIS^® Compliance Audit services, which focus on assisting managed care organizations (MCOs) with reporting valid HEDIS measures. HSAG has been performing NCQA HEDIS Compliance Audits nationwide since 1999. With experience administering HEDIS Compliance Audits across the Medicaid, Medicare, and commercial product lines, HSAG's audit team provides MCOs with valuable expertise and insight to HEDIS protocol and methodology. In addition, HSAG also performs HEDIS Compliance Audits for Preferred Provider Organizations (PPOs) and provides mock-audit services for those gearing up to report HEDIS measures.

Medical Case Review

Medical record review or case review is a cornerstone of HSAG services and a core competency of the company. HSAG conducts individual case review to address quality concerns and assist managed care organizations in addressing and preventing client concerns. During the course of the review, any potential quality-of-care concerns are referred to an HSAG physician reviewer for determination.

Program Evaluation

Coming Soon!

Surveys

As an industry leader in measuring the effectiveness of health care, HSAG has extensive experience in survey management, instrument design, and report development. In 1995, building upon its extensive experience work in the Medicaid and Medicare arenas, HSAG began to develop health outcomes expertise, including patient-reported health status, quality-of-life, and satisfaction surveys.

Technical Assistance

HSAG provides technical assistance to managed care organizations (MCOs) and prepaid inpatient health plans (PIHPs) to address specific activities related to the Balanced Budget Act of 1997 (BBA). This includes the development of tools, training, and technical assistance to be used for quality improvement activities. HSAG makes appropriate recommendations on the need for specific technical assistance and, based on a technical assurance plan, HSAG provides reports detailing the technical assistance provided and the actual outcome or benefits of the assistance.

Technical Reports

The Balanced Budget Act of 1997 (BBA) managed care regulations require that states contracting with Medicaid MCOs or PIHPs ensure that external quality review results of mandatory and any optional EQR activities be described in a detailed technical report. HSAG has extensive experience and is dedicated to generating technical reports that are highly professional, accurate, timely, useful, and able to withstand the rigors of scientific review. As experts both in conducting the EQR activities and in compiling and analyzing findings from the activities, HSAG produces technical reports that meet and exceed the federal requirements and that provide the states and their MCOs and PIHPs with meaningful information and actionable recommendations for improving the quality, timeliness of, and access to care furnished to Medicaid beneficiaries.


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