External Quality Review - Washington Medicaid

Publications

As part of our work as Washington’s external quality review organization (EQRO), Qualis Health produces analytic and technical reports that assess the performance of the state’s managed care organizations (MCOs) and Behavioral Health Organizations (BHOs)—formerly Regional Support Networks (RSNs)—contracted to provide managed care services to Medicaid enrollees. These reports present results of yearly audits and reviews assessing Washington MCOs’ and BHOs’ success in providing Medicaid enrollees with access to timely, quality care.

Reports

Annual Technical Report

The Annual Technical Report describes results of review activities assessing Medicaid enrollees’ access to timely, quality care as provided by Washington State’s managed care organizations (MCOs), providing physical healthcare services, and Behavioral Health Organizations (BHOs), providing mental health and substance use disorder (SUD) treatment services. This report also incorporates results from the Comparative Analysis Report, the Regional Analysis Report, and the individual Behavioral Health Organization (formerly Regional Support Network) reports.

Comparative Analysis Report

The Comparative Analysis Report documents performance among Washington Apple Health MCOs using data from Healthcare Effectiveness Data and Information Set (HEDIS®) measures and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey results.

Regional Analysis Report

The Regional Analysis Report assesses performance among Washington Apple Health MCOs for selected HEDIS performance measures, comparing results across and within the state.

Behavioral Health Organization Reports

These reports document individual performance among the state’s Behavioral Health Organizations (formerly Regional Support Networks [RSNs]) providing mental health and SUD treatment services to Washington Medicaid enrollees. They include results of a review assessing compliance with federal regulatory and State contractual standards, validation of performance improvement projects (PIPs), an Information Systems Capabilities Assessment (ISCA) and an encounter data validation (EDV), as well as a review of progress on prior-year EQR recommendations.

2017 Reports

2017 Annual Technical Report

2017 Comparative Analysis Report

2017 Regional Analysis Report

2017 Behavioral Health Organization Reports

2016 Reports

2016 Annual Technical Report

2016 Comparative Analysis Report

2016 Regional Analysis Report

2016 Behavioral Health Organization Reports

2015 Reports

2015 Annual Technical Report

2015 Comparative Analysis Report

2015 Regional Analysis Report

2015 Regional Support Network Reports

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Questions or Concerns

We understand how important it is to receive quality healthcare services.

As the external quality review organization, Qualis Health's role is to assess the quality of care Medicaid recipients receive.

If you have a concern about the care you or a family member has received, please contact the Washington State Health Care Authority.

»Washington State Health Care Authority