EQRO. It stands for External Quality Review Organization, and it’s another great acronym that Primaris adds to its growing portfolio of work and knowledge.
In Quality Talk Episode 28, “Understanding EQRO,” Primaris Quality Data Services Director Vickie Alexander explains what an External Quality Review Organization does, and the work Primaris will do as the state’s EQRO for overseeing compliance and quality measures among the state’s three Medicaid Managed Care Organizations (MMCOs).
There’s an abundance of “quality” topics under the Primaris umbrella, all of which pertain to healthcare services and healthcare delivery that require reliable, accurate, and actionable data to guide improving processes and patient care. Check out our blog and video, Quality is at the core of who we are and what we do.
Vickie was a guest for an earlier episode of Quality Talk, discussing the question, “Are you drowning in data?” back in Episode 7. She joined Quality Talk host Jodie Jackson Jr. for the “Understanding EQRO” conversation. She was also a primary source for the news release that Primaris posted after receiving Missouri’s EQRO contract: Primaris wins bid for oversight, review of Missouri Medicaid Managed Care Organizations.
In summary, the EQRO contract makes Primaris even more of a partner in the Missouri Department of Social Services/Mo HealthNet Division to assure that Medicaid beneficiaries are receiving “proper care, at the best time, at the best level,” and ultimately for the best outcome, she said.
Vickie offers insight into how MMCOs work (7:24) and details some of the roles Primaris team members will play. One of those tasks is that of a “secret shopper” and making calls to physician/provider offices to schedule a Medicaid appointment. Based on the volume of beneficiaries, each health plan must have a required number of providers that designate adequate space on their schedules for both emergency and regular appointments.
“We can demonstrate whether or not a health plan has failed or met that criteria,” she said.
Whether checking access issues or quality assurance guidelines, the EQRO team will work to identify corrective action - a Performance Improvement Plan (PIP) – with measurable tasks to bring the health plan into compliance. One example: If not enough ear, nose and throat (ENT) docs are available for low-income children, a simple ear infection could become chronic, eventually requiring a much more expensive trip to the emergency room. Primaris is already well-versed in evidence-based guidelines and strategies for improving the health of individual patients and the population as a whole.
As Missouri’s EQRO, Primaris team members will help ensure that Medicaid patients – some 500,000 – receive the same quality care as self-pay or commercially-insured patients.
“It’s about talking and dialogue,” Vickie said. “We’re not the hall monitor waiting to catch somebody doing something wrong.” (21:00)
Primaris, which has a consulting and quality improvement footprint in 27 states, got its start as a quality improvement organization in 1982 (22:50). For more details about the company’s status as a pioneer in the healthcare quality improvement picture, and as a leader in the shift from fee-for-service reimbursement to value-based care, download our ebook, “The Primaris Story.”