External Quality Review
In 1995, the Social and Rehabilitation Services (SRS) of Kansas implemented Medicaid managed care. This is financed through a capitated model, HealthWave (HW), an HMO model which uses Primary Care Physicians (PCP) as gatekeepers, or delivered through the Primary Care Case Manager (PCCM) model, HealthConnect Kansas (HCK). The Centers for Medicare & Medicaid Services requires the state to contract with an outside agency, the External Quality Review Organization (EQRO), to help monitor and improve the quality of care for Medicaid beneficiaries covered under managed care. KFMC was first awarded the EQRO contract for Kansas in 1995. In 2001, the EQRO added work with the State Children's Health Insurance Program (S-CHIP) also called HealthWave.
The scope of an EQRO's activities varies from state to state. In Kansas, KFMC conducts studies involving topics such as prenatal care, children with special healthcare needs, and beneficiary enrollment. Provider and consumer satisfaction surveys are completed annually. The Consumer Assessment of Health Plans (CAHPS) survey instrument is used for the annual HCK consumer survey. The EQRO collects HEDIS performance measures in the areas of pediatric immunization (for HW and HCK) and cervical cancer screening (for HCK). Beneficiary access to healthcare is routinely assessed, as well as provider participation in the KAN Be Healthy program. The EQRO also monitors contract compliance for SRS-contracting HMOs.
Reports
For More Information
Call 1-800-432-0770, or email the External Quality Improvement Project Team.