EQR Protocol 5: Validation and Implementation of Surveys Calculation of performance measures in addition to those reported by an MCO or PIHP and validated by an EQRO Describes the process for the calculation of performance measures in addition to those reported by an MCO and PIHP and validated by an EQRO.
EQR Protocol 6: Calculation of Performance Measures Conduct of PIPs in addition to those conducted by an MCO or PIHP and validated by an EQRO Describes the process for the conduct of PIPs in addition to those conducted by an MCO or PIHP and validated by an EQRO.
Both reports will be available on the CMS Medicaid website. Assess the likelihood that reported improvement is real improvement; and 10.
Meta Star evaluates performance improvement projects (PIPs) that are required by the Wisconsin Department of Health Services (DHS) as specified in its contract with managed care organizations (MCOs) and health maintenance organizations (HMOs), in order to comply with federal regulations.
The purpose of a PIP is to assess and improve the processes and outcomes of health care provided by an MCO or HMO.
EQR Protocol 7 Conduct of studies on quality that focus on an aspect of clinical or nonclinical services as a point in time Describes the process for the conduct of focused, one-time studies on an aspect of clinical and/or non-clinical services at a point in time.
EQR Protocol 8 The EQR protocols contain five appendices available that provide worksheets, additional information on sampling, an acronym listing/glossary, and the MCO/PIHP Information System Capabilities Assessment.
This will enable the Secretary to include results and lessons learned from State intervention strategies to improve care as part of that annual reporting process. In addition, the MCO, on an ad 1 This protocol relies heavily on a guidebook produced by the National Committee for Quality Assurance (NCQA) that identifies key concepts in quality improvement (QI) studies.
Additionally, States may incorporate specific PIPs as part of their State quality strategy, required by Section 1932(c)(1) of the Social Security Act, to align with the HHS National Quality Strategy for Quality Improvement in Health Care. Please see References at the end of this protocol for a list of references that were used to develop this protocol.
The answers should be recorded on a standardized PIP Validation Worksheet (see Attachment A).
Step 1: Review the Selected Study Topic(s) In this step, the reviewer determines the appropriateness of the selected study topic(s).
The state, its agent that is not an MCO or PIHP, or an EQRO may perform the mandatory and optional EQR-related activities.
In accordance with 42 CFR 438.364, the state is responsible for ensuring that each year an EQRO produces a detailed technical report for the state that contains at least the following information: States must provide copies of this information upon request, through print or electronic media, to interested parties.
8 Step 6: Review the Data Collection Procedures Step 7: Review Data Analysis and Interpretation of Study Results Step 8: Assess the MCO s Improvement Strategies Step 9: Assess the Likelihood that Reported Improvement is Real Improvement Step 10: Assess Sustainability of the Documented Improvement ACTIVITY 2: VERIFY STUDY FINDINGS (OPTIONAL) ACTIVITY 3: EVALUATE AND REPORT OVERALL VALIDITY AND RELIABILITY OF PIP RESULTS REFERENCES Attachments Attachment A: PIP Review Worksheet 2 PURPOSE AND OVERVIEW OF THE PROTOCOL This mandatory protocol is used to determine whether a health care quality performance improvement project (PIP) was designed, conducted, and reported in a methodologically sound manner.