What We Do

Medicare Quality Improvement

HSAG's quality improvement organization (QIO) contract with the Centers for Medicare & Medicaid Services (CMS) focuses on improving health care quality for Medicare beneficiaries through collaborations with providers in hospitals, nursing homes, home health agencies, and physician offices, and through partnerships with health and government agencies, managed care organizations, and advocacy groups.

Medicaid External Quality Review

HSAG is nationally recognized as an external quality review organization (EQRO) that evaluates managed care and prepaid inpatient health plans as required by the Balanced Budget Act of 1997, and whose quality review services affect more than 13 million Medicaid recipients, approximately 45 percent of the nation's Medicaid population. HSAG has extensive experience with Medicaid programs in more than a dozen states and thoroughly understands their policies and delivery systems.

Medical Review Services

Medical record review is a cornerstone of HSAG services and a core competency of the company. HSAG performs medical record reviews for care provided to Medicare beneficiaries, Medicaid recipients, military health system beneficiaries, CMS programs, and self-funded employer groups. HSAG also conducts telephonic concurrent reviews and provides consultation and direction to patients and family members regarding utilization management.

Audits

HSAG's audit services assure accurate, reliable, and publicly reportable data that can be used by purchasers and consumers to compare managed care organizations (MCOs). Due to an increase in national interest, our services also assist MCOs and physician organizations with valid and reliable reporting to assess provider performance. HSAG is also a major market leader in providing Pay-for-Performance (P4P) audit services, conducting more than 200 P4P audits since 2003.

Surveys Research & Analyses

HSAG offers outcomes measurement and quality improvement interventions for a variety of governmental and nongovernmental customers, using survey techniques and technologies that yield high response rates and reliable, valid results. Such information allows informed Medicare beneficiaries and Medicaid recipients to make informed choices, and allows states to continually improve the health care delivery system nationally.

Health Information Technology (HIT) Consulting

HSAG provides expert HIT consulting services to health care providers and health plans including electronic medical record implementation, quality performance management techniques, and Pay-for-Performance reporting. HSAG's HIT consulting services focus on cost-effective solutions by making better use of HIT while improving patient care and giving clients a competitive advantage in their respective fields.

Special Studies

HSAG has successfully competed and been awarded special studies by the Centers for Medicaid & Medicare Services (CMS) and other entities to conduct quality research and implement quality projects. These special studies have led to local and national level improvements in quality outcomes, organizational performance, and expanded evidence on best practices for health systems.

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