Acumentra Health Signs Contract to Perform External Quality Review of Oregon's Medicaid Managed Care Program.Review Will Assess the State's Efforts to Ensure That Oregon Health Plan The Oregon Health Plan is the Oregon state healthcare program for low income residents of Oregon. Eligibility Basic eligibility requires that the applicant be a resident of Oregon, as a citizen or otherwise. Enrollees Receive High-Quality Medical Services PORTLAND, Ore. -- Acumentra Health announced today it has signed a contract with the Oregon Department of Human Services, Division of Medical Assistance Programs (DMAP DMAP 4-(dimethylamino) pyridine DMAP Division of Medical Assistance Programs DMAP Deer Management Assistance Program DMAP Direct Matrix Abstraction Program (macro language of NASA Structural Analysis System) ), to perform outside review of the medical and dental services provided to Oregon Health Plan (OHP OHP Oregon Health Plan OHP Overhead Projector OHP Observatoire de Haute-Provence (French observatory) OHP Office of Historic Preservation OHP Oral History Project OHP Occupational Health Psychology OHP Oxford Health Plans Inc. ) enrollees. Federal law requires an annual external quality review (EQR EQR External Quality Review EQR Educational Quality Ranking EQR Environmental Quality Report EQR Enlisted Qualification Record EQR Essential Qualification Requirement EQR Equi-Rectangular ) of state programs such as OHP that deliver Medicaid services through managed care. The EQR contract spans two years ending in March 2009. Acumentra Health previously served as DMAP's EQR contractor from 2003 through 2005 and has performed similar duties under contract with the OHP managed mental health care program since 2004. Acumentra Health will conduct specific review activities required by federal rules that specify how states are to ensure managed care organizations (MCOs) deliver high-quality health care to Medicaid enrollees. The contract covers three primary activities: * Compliance review: determine whether the MCOs are meeting federal standards for enrollee access to health care, structure and operation of managed care plans, and quality measurement and improvement * PIP validation See validate. validation - The stage in the software life-cycle at the end of the development process where software is evaluated to ensure that it complies with the requirements. : determine whether the MCOs are conducting valid performance improvement projects (PIPs) aimed at improving clinical outcomes and service delivery * Performance measure validation: assess whether the state has in place valid measures of MCO MCO Managed care organization, see there performance and whether the MCOs are submitting valid data to enable DMAP to measure their performance Acumentra Health will report to DMAP on each separate activity and will synthesize To create a whole or complete unit from parts or components. See synthesis. the review results for all MCOs in an annual report each year. Currently, DMAP contracts with 22 MCOs to provide medical, dental, and chemical dependency chemical dependency n. A physical and psychological habituation to a mood- or mind-altering drug, such as alcohol or cocaine. chemical dependency services to OHP enrollees throughout Oregon. As of January 2007, nearly 361,000 Oregonians were eligible to be enrolled for these services. Separately, under its contract with the state Addictions and Mental Health Division, Acumentra Health reviews the operations of nine MCOs that provide managed mental health care to OHP enrollees. "Acumentra Health, as Oregon's federally designated Quality Improvement Organization, is most enthusiastic about this opportunity to work with the Division of Medical Assistance Programs to enhance the quality of medical and dental services provided to Oregon Health Plan members," said Jon Mitchell, president and chief executive officer of Acumentra Health. Acumentra Health is a nonprofit organization Nonprofit Organization An association that is given tax-free status. Donations to a non-profit organization are often tax deductible as well. Notes: Examples of non-profit organizations are charities, hospitals and schools. dedicated to improving the quality and effectiveness of health care. Established in 1984, Acumentra Health's work spans the continuum of care, reaching all ages and economic levels, and all delivery settings. Acumentra Health contracts with Medicare to support effective, evidence-based health care for Medicare beneficiaries in Oregon and oversees the state's Medicare Beneficiary Protection Program. In addition, Acumentra Health contracts with state agencies, public health organizations and coalitions, health plans, hospitals, physicians and others to conduct healthcare quality assurance and quality improvement projects. As a leader in healthcare quality, Acumentra Health provides expertise in areas such as performance measurement and improvement, surveys, utilization management Utilization management is the evaluation of the appropriateness, medical need and efficiency of health care services procedures and facilities according to established criteria or guidelines and under the provisions of an applicable health benefits plan. , healthcare data analysis, chronic disease management and electronic health records. For more information, visit http://www.acumentra.org. |
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