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Qualis Health Wins Washington Medicaid External Quality Review Contracts

January 30, 2015

Washington State issues contracts to assess and improve quality of care delivered to Medicaid enrollees

Seattle, WA – Qualis Health has been selected by the State of Washington Health Care Authority (HCA) and Department of Social and Health Services (DSHS) Division of Behavioral Health and Recovery to perform external review and support quality improvement for Washington Apple Health, the state's Medicaid program. Under these contracts, Qualis Health will provide external review of care delivered to enrollees of Washington Apple Health managed care programs and the Pre-Paid Inpatient Health Plans providing mental health services. The three-year contracts run through 2017.

"With the tremendous expansion of Apple Health following implementation of the Affordable Care Act, it's more important than ever to assure healthcare quality and value for the Medicaid population," said Jonathan Sugarman, MD, MPH, President and CEO of Qualis Health. "With these contracts, we are partnering with the State of Washington to ensure that healthcare system performance is objectively evaluated, and that the results of our external review are used for public accountability and on-going improvement."

The contract with the HCA focuses on care provided by Apple Health managed care organizations, presently serving over 1,200,000 Washingtonians. The contract with the DSHS Division of Behavioral Health and Recovery addresses care provided by Regional Support Networks that provide community-based mental health services.

In Washington State, Qualis Health also serves as the Quality Improvement Network-Quality Improvement Organization (QIN-QIO) for the Centers for Medicare & Medicaid Services (CMS), the Health Information Technology Regional Extension Center (REC) for the Office of the National Coordinator for Health Information Technology (ONC), and provides care management services to the Washington State Health Care Authority, Washington State Department of Labor & Industries and private insurers.

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