External Quality Review Organization (EQRO)
KFMC has held the Kansas EQRO contract since 1995, when the State of Kansas implemented Medicaid Managed Care. Our current contract extends through December 31, 2014. EQRO activities focus on quality review and improvement related to access, quality, and timeliness of healthcare. Currently, Social & Rehabilitation Services' (SRS) Disability and Behavioral Health Services, and the Kansas Health Policy Authority (KHPA) contract with KFMC for EQR services. The work for KHPA entails external quality review activities related to the HealthConnect Kansas (Medicaid Primary Care Case Management program) and HealthWave (Medicaid and SCHIP Managed Care program). The SRS contract includes review of Mental Health and Substance Abuse programs.
The EQRO follows the Centers for Medicare & Medicaid Services (CMS) External Quality Review Protocols for the following activities:
- Validation of Performance Improvement Projects
- Validation of Performance Measures
- Validation of Encounter Data (including Information Systems Capabilities Assessment)
- Validation of Surveys (Provider and Consumer)
- Conducting Focused Studies
- Calculating Performance Measures
- Conducting Surveys (Provider and Consumer)