eQHealth Solutions provides our clients with a broad range of services; all designed with the ultimate goals of reducing or containing health care costs, improving the quality of care and creating operational efficiencies in complex systems.

Our services help our clients evaluate care management and quality improvement outcome measures, analyze health care trends based on millions of Medicare and Medicaid claims, establish metrics and baselines for program design and implementation and assess return on investment for clinical management programs.

OUR SERVICES:

Care Coordination
Our approach to care coordination is designed to meet the needs of Medicare, Medicaid, state and local human service agencies and commercial health plans. Based on national, evidenced-based principals, our suite of care coordination products bring together an array of health care services to achieve consumer-directed care. The result is a reduction in fragmented care through participant education, case management, patient assessment and coordination between care providers.

Health Information Technology Consulting
Our health information technology specialists are knowledgeable of all components of certified health information systems. From education about federal funding opportunities to helping practices successfully adopt EHRs in their offices, we work with physicians and their staffs through all stages of the transformation from paper records to digital.

Utilization Management
We integrate our deep clinical resources with out proprietary utilization management software and a collaborative approach to working with providers that result in significant cost containment. We offer:

• Experienced clinical staff.
• Web-based interfaces with providers and payors.
• Smart Reviews – Clinical algorithms that automatically drive quality and utilization management processes
• Sophisticated call center operations.

Clinical Quality Improvement
In our nationally recognized health care quality improvement programs, we work with our clients to improve health outcomes. Our services include:

• Developing quality improvement initiatives and strategies.
• Data collection and reporting expertise.
• Assessing quality outcome metrics and promoting transparency.
• Consulting and educating on pay for performance initiatives.
• Educating providers on clinical standards and best practices.

Information Technology Services
We are IT leaders. Whether it’s software development, system architecture, database administration, business analysis and project management, we have more than 25 years experience designing solutions that meet the individual needs of a variety of clients.

Analytics: Evidenced-Based Decision Support
Our staff of PhD and Masters-level statisticians works with clinical information and administrative claims data to conduct a variety of program assessments. These health care analytics include quality improvement measures, establishing metrics and baselines for program design, and analyzing health care trends.

Our ability to conduct detailed analyses and studies provides our clients with the decision support necessary when contemplating new policies, programs and/or services.

Home and Community Based Services (HCBS) Services
eQHealth offers technical assistance, custom IT solutions and quality management consulting on home and community based waiver services. We provide expert consultation on waiver application, program design and program compliance. Our custom, Web-based IT systems help our clients conduct assessments, collect plan of care data, develop reports, monitor clients and providers, and conduct utilization and medical necessity reviews.

Provider Education
We have extensive experience working with providers. On behalf of our clients, we conduct education to all providers for services that we render to Medicaid and Medicare. We ensure the providers fully understand the medical management requirements and quality improvement guidelines that are required by government agencies.

Our intensified educational offerings may include the following topics:

• Medical necessity criteria.
• Techniques to improve utilization management processes and systems.
• Training of provider staff on state and/or federal policies.
• Quality improvement techniques.
• Proper documentation and substantiating medical necessity.

 
Project Evaluation
For our large clients, we use a project evaluation process that has been adopted by the health sciences programs in the nation including the National Institute of Medicine (IOM) and Agency for HealthCare Research and Quality (AHRQ), Centers for Medicare and Medicaid (CMS) and the Joint Commission for Hospital Accreditation.

SOLUTIONS FOR MEDICAID AGENCIES
We have a successful history of helping Medicaid agencies generate very strong returns on investments. Our success is built on an understanding of Medicaid patients and providers, and our ability to build effective relationships with physicians and our clients.

In Mississippi, eQHealth is the Medicaid QIO for the State of Mississippi and is Utilization Review Accreditation Commission-certified as a utilization management organization.

We operate a large call center in Jackson, and have been conducting quality and utilization management services in an array of inpatient and outpatient settings since 1997.

In Illinois, we are the Medicaid QIO for the State of Illinois, conducting quality and utilization management for inpatient acute medical/surgical, behavioral health and detoxification hospitalizations.

In Florida, the Agency for Health Care Administration (AHCA) awarded eQHealth
Solutions a three‐year contract to conduct Medicaid utilization management services. The contract began June 1, 2011. eQHealth Solutions is implementing a comprehensive Medicaid utilization management program that is designed to prevent unnecessary or inappropriate use of services, protect against excess payments and assess the quality of health care services provided to Medicaid recipients.

We have consistently achieved significant impact in quality of care and program savings. We also conduct clinical research projects, develop criteria and provide extensive consultation for Illinois’ Home and Community-Based Services (HCBS) waiver programs.

We bring the following expertise to our Medicaid clients:

• Utilization review services for participant eligibility and medical necessity.
• Technical assistance and management consulting.
• Developing custom IT systems with our in-house staff.
• Innovation and cost effective solutions.
• Expert consultation on waiver application and program design.
• Quality management consulting and quality reviews for program compliance.
• Internal and CMS reporting.
• Provider and client monitoring.
• Successful implementation of new programs.

Bringing Innovation to Medicaid
eQHealth is dedicated to providing technical solutions that are designed to reduce our client’s paper tasks while increasing the efficiency of their medical management processes. Some of these innovations include:

• 100% imaging of all review documents.
• SMART Reviews (Automated Rules-Based Certification System) that maximizes financial resources for clients.
• Web-based physician reviews that yield faster review decisions.
• Online seamless review at all stages which facilitates process management by paperless workflow queues.
• Secure Web mail protocol to exchange protected health information communications.

Web-based modules for providers to submit reviews, run reports, check status and submit questions.

WE GET RESULTS

Nationally Recognized For Innovation
Recently, eQHealth was one of only several companies that received funding from CMS for two sub-national contracts to improve the quality of care for Medicare patients.

Care Transitions – This is a quality improvement initiative associated with patients transitioning from hospital care to other levels of care.  The project is designed to better coordinate care by identifying and implementing a variety of interventions in hospitals and the community that will improve the discharge process and avoid unnecessary readmission of patients. The goal is to reduce avoidable hospital readmissions and improving medication management and post-discharge follow-up.

Disparities – This is an effort to address health care disparities for diabetic patients associated with racial and socio-economic factors.

Medicaid Programs Save Money
Over the past four years, we have helped one state Medicaid program save in excess of $25 million annually. The average annual return on investment for this client is 3.3:1.

We have helped a second state save in excess of $50 million annually for the past four years. The ROI for this client exceeds an annual average of 7.1:1.

We have helped one state reduce their total days of care from 5.46/1,000 to 3.88/1,000

QUALITY IMPROVEMENTS*

Improving Nursing Home Care Quality in Those Nursing Homes
Working Intensely with eQHealth
• Significant reductions in patients with bedsores or in use of physical restraints.
• Fewer residents with pain.

Improved Hospital Care Quality in Those Hospitals
Working Intensely with eQHealth
•  Improved care for heart attacks by 59 percent.
•  Improved pneumonia care by 55 percent.
•  Improved congestive heart failure care by 66 percent.

*QIO Data from CMS

For information about how eQHealth Solutions can improve quality in your state, contact Mayur Yermanini, Director of Corporate Business Development at
(225) 926-6353.