Quality Improvement & External Quality Review




External Quality Review Organization - Helping States Monitor Their Managed Care Entities

To ensure that Medicaid recipients receive high quality, appropriate care, agencies need to engage independent external quality review organizations (EQROs) to assess the performance of their managed care entities.

Leveraging our extensive national experience and drawing on our depth of clinical expertise,  APS helps states meet the EQRO requirement with comprehensive services that monitor quality of care, finances, encounter data, access and provider networks, and grievances, with the goal of:

  • Improving health outcomes
  • Increasing consumer satisfaction
  • Delivering care that is accessible, coordinated, and of high quality

APS is designated by the Centers for Medicare and Medicaid Services (CMS) as a QIO-like organization, allowing states to receive a 75% matching reimbursement.

Our EQRO services include:

  • Information system capability assessments
  • HEDIS reviews and program analysis
  • Performance measure validations, improvement plan development, implementation and review
  • Ongoing training, education and technical assistance during and after reviews
  • Medical education interventions for facilities, physicians and other providers
  • Comprehensive data collection, analysis and reporting
  • Continuous quality improvement and outcomes management