External Quality Review
Improving Medicaid Managed Care quality and performance.
Don’t just meet your quality goals — exceed them
As an External Quality Review Organization (EQRO), Acentra Health monitors the quality of programs and services provided by your managed care partners. Our team of medical and technical experts analyze volumes of data to identify opportunities to improve the timeliness, quality, and access to care.
We deploy an integrated team of medical and technical experts who analyze data, identifying issues related to timeliness, quality, and access to care. This process reveals the nuances of program performance, including its impact on population health. For example, we provide valuable, actionable feedback to plans about their PIP (performance improvement projects) programs, including an evaluation of project design, validation measures, and interventions.
As a result of our comprehensive model, states can meet EQRO requirements while ensuring that members are receiving the highest-quality, most efficient, and appropriate care.
Acentra Health is committed to helping
Medicaid agencies achieve
Improved health outcomes
Accessible, coordinated,
high-quality care
Increased member satisfaction
Robust EQRO Capabilities
- Information system capability assessments
- Healthcare Effectiveness Data and Information Set (HEDIS) reviews and program analysis
- Performance measure validation
- Performance 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
Improve healthcare quality oversight with
our cross-functional solutions
Appeals & Grievances
Reach successful conclusions with flexible processes that work for your organization's unique systems and criteria.
Standard of Care Review
Promote continuous quality improvement through objective quality reviews.
CMS Waiver Oversight
Achieve high-quality long-term services and supports with comprehensive Medicaid waiver oversight and accountability.
Get Started with Acentra Health
Connect with an expert from our team and learn more about how
Acentra Health's solutions and services can benefit your organization.