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Health Services Advisory Group Inc. (HSAG), with headquarters in Phoenix, Arizona, on August 1 took over the quality review functions, or "PRO Activities," for the Hawaii Department of Human Services' Med-QUEST Division. These functions include utilization review services, level-of-care determinations for long-term care, preadmission screening, and resident referrals for nursing facilities.

HSAG already had been serving as the state's Medicaid external quality review organization, or EQRO, since 2001. The additional PRO Activities work consolidates all quality efforts under an experienced company with highly qualified staff.

As a first step under the new contract arrangement, HSAG opened an office earlier this summer in Honolulu. The office staff includes an executive director, two nurse reviewers, one medical director, and one administrative assistant. Since August 1, the transition of work from the previous contractor to HSAG has been a smooth one, in part because of sufficient training time and because phone numbers were kept the same to eliminate confusion.

"We have worked to build a solid and successful working relationship with Med-QUEST over the past four years, and it is our goal to establish, cultivate and grow the relationship for many years to come," said Herb Rigberg, MD, HSAG's chief executive officer.

HSAG is one of the largest EQRO contractors in the nation and currently provides external quality review services in 10 states, representing approximately 21 percent of the nation's Medicaid population. In Hawaii, HSAG oversees the quality of Medicaid services for some 180,000 enrollees.

EQRO services for Med-QUEST have included validating performance improvement projects (PIPs) for the QUEST health plans and the Child and Mental Health Division (CAMHD), along with validating performance measures, monitoring compliance with federal standards, and conducting provider and CAHPS satisfaction surveys. HSAG also prepares a detailed annual external quality review technical report of the results of mandatory activities, describing the quality, timeliness, and access to care provided by the QUEST plans and CAMHD.

HSAG has an additional contract to conduct encounter data validation and omission studies for the QUEST plans, using the guidelines set forth in the CMS protocols.