MPRO External Quality Review (EQR) Services

MPRO EQR Qualifications

• Federally designated Quality Improvement Organization (QIO) for over 20 years
• More than a decade of continuous EQR experience
• EQRO contracts in multiple states
• National Committee for Quality Assurance (NCQA) staff expertise
• Significant managed care expertise – Medicaid, Medicare, commercial

Services Offered

MPRO has extensive experience in External Quality Review (EQR) activities, as well as in designing and implementing customized programs to meet our clients’ needs. State agencies can derive tremendous value from MPRO’s EQR services - awareness of Medicaid managed care challenges and potential solutions can lead to greater efficiencies, cost-savings, and ultimately, higher customer satisfaction. MPRO’s EQR services include, but are not limited to:

• Assessment of managed care organization (MCO) compliance with state, federal
  and contractual requirements
• Validation of performance improvement projects (PIPs)
• Validation of performance measures
• Conduct of focused clinical studies (e.g., EPSDT, prenatal care, asthma, STDs,
  colorectal cancer, breast cancer, diabetes, otitis media, CSHCN, and others)
• Preparation of Annual Technical Reports (ATRs)
• Provision of technical assistance to states and MCOs
• Development of data collection tools
• Abstraction of medical records
• Validation of encounter data
• Review and assessment of state quality strategy
• Administration and validation of surveys
• Review of care treatment plans, access to women’s health services, cultural
  sensitivity, and advance directives

Qualified Staff

MPRO staff has extensive experience with all aspects of mandatory and optional EQR activities and have a proven track-record of exceeding customer expectations in multiple states.

Our highly qualified staff includes seasoned managed care professionals whose experience span the past two decades of implementing quality improvement, utilization management, and disease management programs. Our team has many years of Medicaid managed care operations and behavioral health experience, and has access to an established network of experts in various EQR-related areas.