IPRO Wins PA Medicaid Evaluation Contract

IPRO has won a three year renewal of a major contract with the Commonwealth of Pennsylvania to review the quality of services provided to Medicaid recipients enrolled in managed care plans across that state. Under the terms of the External Quality Review Organization (EQRO) contract, IPRO will evaluate how well health plans manage specific clinical conditions and will analyze quality using medical records, eligibility data, claims/encounter data and patient satisfaction surveys. The three-year agreement includes an option to renew the contract for two additional one-year terms. EQRO contracts assure that Medicaid programs are evaluated by independent, external organizations. IPRO has held the Pennsylvania EQRO contract continuously since 1999. “We are gratified that Commonwealth of Pennsylvania has seen fit to renew our EQRO contract,” said IPRO Chief Executive Officer Theodore O. Will. “Given the highly competitive nature of the healthcare evaluation marketplace, this renewal demonstrates the high-level skills and analytic capabilities of our managed care evaluation team.” Contract managers at the State’s Department of Public Works have identified 20 explicit objectives for assessing the performance of managed care plans, addressing behavioral as well as physical health. IPRO’s oversight responsibilities also include Medicaid managed long term care. For the first time, IPRO’s purview will be extended to include review of Children’s Health Insurance and Adult Community Autism Programs.