Lesson 2: Introduction to EQR Protocols

Introduction to EQR Protocols

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📖 What are EQR Protocols?

Introduction to EQR Protocols

What are EQR Protocols?

CMS is required to develop EQR protocols to guide and support the annual EQR process. CMS If you recall the history of EQR from Lesson 1, the first set of protocols were developed in 2003, revised in 2016, and again in 2018. The revised protocols were released in 2023, and currently in use.

📖 What are EQR Protocols?

Introduction to EQR Protocols

What are EQR Protocols?

How to conduct each activity within the protocol including:

Each protocol describes:

• Data sources and data collection activities to promote data accuracy, validity, and reliability
• Proposed methods for analyzing and interpreting data, and
• Instructions, guidelines, worksheets, and/or tools that may be used in implementing the protocol

Purpose of the EQR-related activity

📖 Information Systems Capability Assessment (ISCA)

Introduction to EQR Protocols

Information Systems Capability Assessment (ISCA)

Protocols 1, 2, 3, 4, 5, and 7 require each state to assess their MCPs' information system (IS) capabilities. ISCAs help ensure that each Managed Care Organization (MCO) maintains a health information system that can accurately and completely collect, analyze, integrate, and report data on member and provider characteristics, and on services furnished to members. You will learn more about ISCAs and how the ISCA Tool (ISCAT) is used for each protocol in future lessons.

Introduction to EQR Protocols

Mandatory and Optional EQR Protocols

Mandatory and Optional EQR Protocols

• Over the next few slides we will identify the EQR protocols linked to each of the mandatory and optional EQR-related activities, as well as the regulations that guide the protocols. As you review the protocols, click on the blue pointer icon for each protocol to learn more.

📖 Mandatory EQR Protocols

Introduction to EQR Protocols

Performance Improvement

Performance Measurement

Area of Review

MCP Compliance

Protocol 3:Review of Compliance

Protocol 4:Validation of Network Adequacy

Protocol 2:Validation of Performance Measures

Protocol 1:Validation of PIPs

Mandatory EQR-Related Activities

Information Systems (IS)

IS Capabilities Assessment (ISCA) Mandatory in Protocols 1, 2, 3, 4 Applicable to Protocols 5,7

📖 Optional EQR Protocols

Introduction to EQR Protocols

Performance Measurement

Protocol 6: Administration or Validation of Quality Care Surveys

Protocol 5: Validation of Encounter Data (EDV)

Protocol 7: Calculation of Additional Performance Measures

Optional EQR-Related Activities

📖 Optional EQR Protocols

Introduction to EQR Protocols

Performance Improvement

Protocol 10: Assist with Quality Rating of Medicaid and CHIP MCOs, PIHPs, and PAHPs

Protocol 9: Conducting Focus Studies of Health Care Quality

Protocol 8: Implementation of Additional PIPs

Optional EQR-Related Activities

📖 Preparing for EQR-Related Activities

Introduction to EQR Protocols

Preparing for EQR-Related Activities

Preparing to conduct EQR-related activities involves several steps. EQR-related activities may be performed by the state, an agent of the state that is not an MCP, or by an EQRO. Regardless of which entity performs EQR-related activities, the data from all activities must be independently reviewed and evaluated by the EQRO as part of the annual EQR and EQR technical report.

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📖 Nonduplication for EQR Activities

Introduction to EQR Protocols

Nonduplication for EQR-Activities

Nonduplication is intended to reduce the administrative burden on MCPs and states while ensuring relevant information is available to EQROs for the annual EQR.

📖 Nonduplication for EQR Activities

Introduction to EQR Protocols

Nonduplication for EQR-Activities

Nonduplication allows a state to use information from a Medicare or private accreditation review of an MCP in place of generating that information through one or more of three mandatory EQR related activities (Protocols 1–3). To do so, the following conditions must be met:

📖 Knowledge Check

Introduction to EQR Protocols

Knowledge Check

Introduction to EQR Protocols

Introduction to EQR Protocols

📖 Qsource's EQR Activities by State: Mandatory Protocols

Qsource's EQR Activities by State: Mandatory Protocols

EQR Activities

Florida

Tennessee

Arkansas

Indiana

Protocol 1: Performance Improvement Projects

Protocol 2: Validation of Performance Measures

Protocol 3: Review of Compliance

Protocol 4: Validation of Network Adequacy

Introduction to EQR Protocols

📖 Qsource's EQR Activities by State: Mandatory Protocols

Qsource's EQR Activities by State: Optional Protocols

Tennessee

Arkansas

EQR Activities

Florida

Indiana

Protocol 5: Encounter Data Validation (EDV)

Protocol 6: Administer or Validate Consumer or Provider Surveys

Protocol 7: Calculation of Additional Performance Measures

Protocol 8 : Implementation of Additional PIPs

Protocol 9 : Conducting Focus Studies of Health Care Quality

Introduction to EQR Protocols

📋 How to use the EQR Protocol Guide

How to use the EQR Protocol Guide

The EQR Protocol Guide is the dictionary of all things related to EQR Protocols, and provides you with the information and tools needed to perform EQR-related activities. Click on the pointer button here to learn more about navigating the EQR Protocol Guide.

📖 Knowledge Check

Introduction to EQR Protocols

Introduction to EQR Protocols

Congratulations!

Congratulations! You have completed Introduction to EQR Protcols

If you have any questions about this lesson, please contact your Program Manager, or your course instructor. You may also leave a message in the chat boards. You are now ready to move onto the next lesson, Drafting EQR Technical Reports

📩 mhoover@qsource.org 🗓 Michelle Hoover 🌍 Team Trainer EQRO Division