Qlarant’s EQRO activities included the development of the methodology for the measurement of MCO performance against standards that are contained in the MCO contract, as well as state and federal regulations. Qlarant was responsible for the performance of mandatory and optional activities as described in 42 CFR 438.
The EQRO report provided the regulatory and contract compliance and performance outcomes of the ND Healthy Steps Program contracted MCO. The EQRO report results provided the assessment of quality, access, and timeliness of the services provided by the MCO and opportunities for improvement.
The EQRO Technical report included the following:
- Validation of the MCO’s encounter data as described in 42 CFR 438 indicating objectives; methods of data collection and analysis; description of data obtained; and conclusions drawn from data.
- Administration or validation of consumer or provider surveys of quality of care as described in 42 CFR 438 indicating objectives; methods of data collection and analysis; description of data obtained; and conclusions drawn from data.
- Validation, in collaboration with the MCO, of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) tool. The EQRO was to work with the MCO to develop supplemental questions in relation to performance improvement plans or other identified criteria, if necessary. The MCO mailed, tabulated, and reported the results to the EQRO. The EQRO validated the results. After validation, the results were shared with the State.
- Annual review the MCO’s plan for identifying non-English languages spoken by members. The EQRO also monitored how the MCO was striving to improve the quality of health care for multicultural populations by ensuring that services were available, accessible, and provided in a culturally and linguistically appropriate manner.
- Annual review of the adequacy of the MCO’s network. The EQRO ensured that the MCO had plans in place to pay for and coordinate care or services if the MCO was unable to provide necessary covered services in a timely manner.
- Annual review of information to beneficiaries, grievances, and provider selection during the EQRO’s onsite review.
- Annual assessment of program measures, including program impact, timely access, quality, cost effectiveness, beneficiary choice, and provider selection and other areas of service or service delivery of the health plan.
- Making recommendations for quality improvement and cost containment initiatives when opportunities were identified in the course of monitoring activities performed for this contract.
- Providing technical assistance and guidelines to the managed care contractors, including EQR related activities and quality improvement, as requested by STATE or the ND Healthy Steps MCO.
- Performing State-directed quality and/or performance ad hoc review activities.
