The Oklahoma HealthCare Authority Selects KFMC Health Improvement Partners as Awardee of Multiple Contracts
The Oklahoma HealthCare Authority (OHCA) has selected KFMC Health Improvement Partners (KFMC) as the Prime awardee for both the External Quality Review Organization (EQRO) and Quality Improvement Organization (QIO) Contracts effective April 1, 2021. The OHCA is the state agency that administers the Oklahoma Medicaid Program known as SoonerCare. Medicaid is a federal entitlement program that provides funding for medical benefits to certain low-income individuals who have inadequate or no health insurance coverage. As the designated EQRO for Oklahoma, KFMC will analyze and evaluate aggregated information on quality, timeliness, and access to the healthcare services that a managed care plan, or its contractors, furnish to Medicaid beneficiaries enrolled in the Oklahoma Managed Care program, slated to begin October 1st. As the QIO, KFMC will provide independent and objective post-payment utilization review of both inpatient stays and outpatient observation services.
KFMC has worked with the State of Kansas as the EQRO since the inception of Medicaid Managed Care in 1995. Over the past 25 years, KFMC has assisted with onboarding 9 Managed Care Organizations, 7 Pre-Paid Inpatient Health Plans and 1 Pre-Paid Ambulatory Health Plan. KFMC has also provided utilization review, Diagnosis Related Group validation, and quality of care review services since 1982. Under this contract, KFMC is subcontracting some of the work to the Oklahoma Foundation for Medical Quality (OFMQ), an organization headquartered in Oklahoma City, Oklahoma, with extensive clinical care review and quality improvement experience. While KFMC will still provide most of the EQRO services and provide oversight of the utilization review activities, OFMQ will primarily be responsible for the Inpatient, Outpatient and payment reviews.
“We are excited to be able to leverage our experiences with Managed Care implementation in Kansas to assist OHCA in efficiently and effectively executing their comprehensive managed care delivery system for SoonerCare members,” said Sarah Irsik-Good, KFMC’s chief executive officer. “Our staff has extensive clinical and regulatory compliance experience, and by partnering with OFMQ, and adding their expertise and knowledge of the Oklahoma healthcare delivery environment, we are able to offer an even higher quality of service to the State of Oklahoma, to healthcare providers, and most importantly, to Oklahoma’s Medicaid members.”
About KFMC: Across numerous states, KFMC advises physician practices, hospitals, nursing homes and state agencies on how to achieve higher levels of performance and deliver better health outcomes for patients. With deep expertise and experience in clinical improvement, health information technology utilization, performance measurement, data collection, analysis and validation, population health management, and community engagement, KFMC equips health organizations of all types with insights and proven approaches in areas that matter most to each organization.
About OFMQ: OFMQ is a nonprofit, consulting company dedicated to advancing healthcare quality. Since 1972, it has been a trusted resource through collaborative partnerships and hands-on support to healthcare communities. OFMQ are experts in analytics, case review, education, health information technology, IT consulting, national quality measures, and quality improvement. Learn more at www.ofmq.com.