Quality Assurance and Performance Improvement
WHAT IPRO OFFERS
Utilization review and quality assurance
Health care program monitoring
Beneficiary protection activities
Provider clinical performance improvement services
HOW IPRO BENEFITS CLIENTS
- Over five years, helped a state Medicaid agency recoup over $1 billion in Medicaid funds through effective retrospective admission/length-of-stay reviews and DRG recoding in acute care hospitals and ambulatory settings. This savings represented a benefit:cost ratio of over 15:1.
- Developed and implemented the first systematic, statewide monitoring program to evaluate the performance of Early Intervention (EI) providers. Conducts more than 600 on-site reviews annually.
- Over a seven year period, improved compliance of a northeastern state's 120 teaching hospitals with resident work-hour requirements by 50% through on-site survey audits, resident interviews and comprehensive educational and training programs.
- As the End Stage Renal Disease Network (ESRD) for a mid-Atlantic state, partnered with the Centers for Medicare & Medicaid Services and renal stakeholders to support the national quality improvement project, Fistula First Breakthrough Initiative; this resulted in a 3% increase in the use of arteriovenous fistulas (AVFs) in hemodialysis patients over a one-year period.
- Provided coordination and support for the operation of all 18 ESRD Networks across the country.
- Returned, in as few as 24 hours, over 1,000 binding clinical decisions a year resolving health care coverage disputes on behalf of 15 states and the District of Columbia.
