(Easton, MD) September 16, 2016 - The Maryland Department of Health and Mental Hygiene (DHMH) recently awarded Delmarva Foundation with an additional five-year contract as the Maryland External Quality Review Organization (EQRO). Delmarva Foundation, a subsidiary of QHS, has formally served as Maryland EQRO since 2002. The company has been evaluating Maryland’s managed care program since 1997 when it was a voluntary program.
“Delmarva Foundation’s experience is unparalleled,” said Roxanne Rodgers, Senior Vice President. “We have successfully conducted high quality Systems Performance Review (SPR) audits of the HealthChoice MCO since the program’s inception in 1997.”
“As Maryland’s EQRO, Delmarva Foundation monitors and reports on the quality-of-care provided by the Medicaid MCOs in the State. Delmarva Foundation performs an intensive on-site, two-day audit of each of the eight MCOs annually to assess and monitor plan compliance with federal and state regulations and contractual requirements. The review team assesses the MCOs’ structures, processes, and outcomes related to medical record-keeping practices; their credentialing program; outreach efforts; utilization management; quality assessment and performance improvement; and fraud and abuse program activities. Delmarva Foundation prepares monthly progress reports, orientation manuals, and MCO compliance review reports (preliminary and final) for each MCO annually as well as an annual technical report.
The EQRO also validates performance measures used for the state’s value-based purchasing incentive program; conducts performance improvement project validations and an analysis of results; performs encounter data validation activities; and conducts an annual focused review and analysis of Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services provided by the MCOs. In addition, Delmarva Foundation produces the annual HealthChoice consumer report card.
The new contract will add the following additional tasks:
- Consumer focus groups for the revision of the consumer report card
- Quarterly analysis of pre-service denials, appeals, and grievances
- Network analysis and secret shopper surveys
Delmarva Foundation assures DHMH and the HealthChoice MCOs uninterrupted services. The highly-experienced and qualified EQR team will continue to provide customized services, deliverables, and technical assistance in a manner that continues to exceed DHMH expectations. Team members keep abreast of the latest developments in health care quality improvement, state health policy, and federal and local regulations.
Delmarva Foundation and our subcontractors are keenly familiar with the required scope of work, operating procedures, contract monitoring staff, and expectations. “We will continue to meet and exceed the Department’s expectations,” said Jody Jobeck, Senior Director. “We look forward to collaborating and supporting the Department on day 1 of contract execution.”
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About Delmarva Foundation
Delmarva Foundation for Medical Care is a subsidiary of Quality Health Strategies and is an ISO 9001:2008 certified company. For more information visit www.delmarvafoundation.org and www.qualityhealthstrategies.org.