Improving Oversight of Managed Care Quality in Medicaid and CHIP

​This project supported the Centers for Medicare & Medicaid Services (CMS) in its efforts to advance and improve the External Quality Review (EQR) process for monitoring and overseeing the quality of health care provided by state Medicaid and CHIP managed care programs. The project team abstracted and analyzed information on state activities related to measuring and improving quality performance from state 2013-2014 EQR technical reports.

NORC developed, populated, and maintained a system to analyze the contents of the EQR reports and create profiles of each states' EQR efforts, including MCO and PIHP performance measurement requirements and performance improvement projects (PIPs). In addition, NORC conducted specific analyses focused on encounter data validation activities, behavior health performance measures and PIPs, and EQR deeming options. NORC also reviewed CMS' Medicaid managed care quality oversight process and proposed strategies for improving CMS' processes and procedures for Medicaid and CHIP managed care oversight. Through interviews with states, NORC assessed the usefulness and value of the EQR process to state Medicaid programs.