Seattle – The Washington State Department of Social and Health Services (DSHS) awarded Qualis Health, a nonprofit healthcare quality improvement organization, a contract to provide analysis and review of two fee-for-service programs that serve Medicaid patients. The contract includes a care management component assessing inpatient care and a survey method to evaluate patient satisfaction with disease management.

Qualis Health, which has broad expertise evaluating and improving healthcare services for Medicaid clients in several states, will provide care management services through a retrospective utilization management evaluation with Washington State hospitals that serve fee-for-service patients. At the same time, the nonprofit organization will administer a satisfaction survey with Medicaid clients who have enrolled in disease management programs.

Qualis Health will be administering the Consumer Assessment of Health Plan Satisfaction, also referred to as CAHPS®. CAHPS refers to a comprehensive and evolving family of survey instruments that are designed to capture the experiences of consumers and patients with a range of healthcare products and services. For this contract, it will be used in evaluating the satisfaction with disease management programs offered to Medicaid clients with certain chronic diseases. The utilization management evaluation will include the review of the medical necessity of hospital admissions and also assess the correct coding of select Washington state hospital claims.

These services are required by the Centers for Medicare & Medicaid Services (CMS) and allow the state’s Medicaid program to assess the adequacy of inpatient care being delivered to Medicaid patients. The results from these programs can assist the Washington state Medicaid program to identify and implement healthcare quality improvement opportunities.

“In winning this contract, Qualis Health brings 26 years of experience evaluating and improving the quality of care for Medicaid beneficiaries,” said Jonathan Sugarman, MD, MPH, president and CEO of Qualis Health. “This contract continues our efforts to meet the needs of Medicaid agencies by providing high quality, cost effective review services.”