MPRO Awarded Three New Contacts

MPRO, Michigan’s Quality Improvement Organization (QIO), was recently awarded three new contracts: Reducing 30-day Rehospitalizations and Improving Care Coordination Among Beneficiaries with Chronic Disease and Behavioral Health Conditions contract, Online Resource Center: A Unique Approach to Engaging Medicare Beneficiaries with Dementia and their Families in their Care contract and Post Payment Hospital Audits.

Reducing 30-day Rehospitalizations and Improving Care Coordination Among Beneficiaries with Chronic Disease and Behavioral Health Conditions

For this contract, MPRO will collaborate with area providers to reduce 30-day hospital readmissions and emergency department (ED) utilization for patients with co-morbid medical and behavioral health conditions. We will be recruiting and working with hospital systems, downstream providers, community-based organizations and consumers to:

·         Develop community coalitions that encourage learning, peer sharing, testing of evidence-based interventions and spread of best practices

·         Provide technical assistance on improving care coordination with regard to the screening and treatment of those with medical and behavioral co-morbidities

·         Incorporate consumer and stakeholder engagement in the development of increased awareness of behavioral health needs in the holistic and person-centered approach to patient care

Online Resource Center: A Unique Approach to Engaging Medicare Beneficiaries with Dementia and their Families in their Care

MPRO is committed to improving the lives of Michigan Medicare beneficiaries diagnosed with dementia, their families and caregivers. To help this population, MPRO will create an interactive online resource center (ORC) for those diagnosed with dementia, their families and/or caregivers. The ORC will provide easily accessible, user-friendly information about dementia in order to improve the patient/family/caregiver partnership.

Medicare beneficiaries diagnosed with dementia, their families and/or caregivers will provide feedback on each stage of the ORC’s design and development to ensure the tools and resources are effective, easy to access, user-friendly and appropriate. We will create an advisory panel comprised of consumers, stakeholders and providers. The intent of the ORC is to compliment, rather than duplicate, other resources currently available.

Post Payment Hospital Audits

For more than 25 years, MPRO has provided utilization and quality review services for the Michigan Department of Community Health’s (MDCH) Office of Health Services Inspector General (OHSIG). History shows MPRO has consistently saved the State millions of dollars each year through utilization review efforts. This three-year contract, which commenced July 1, 2013, will enable MPRO to continue its work with MDCH’s OHSIG and provide the state substantial savings by means of recovery of overpayments through retrospective review of Medicaid claims.

For more information, contact Anne Hein at ahein@mpro.org or 248-465-7340.

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ABOUT MPRO

MPRO (www.mpro.org) is an independent nonprofit organization and a national leader in health care quality improvement and medical review. MPRO serves as the federally designated quality improvement organization (QIO) for Michigan under contract with the U.S. Centers for Medicare & Medicaid Services. In its role as a QIO, MPRO is charged with the following:

·         Improve quality of care for beneficiaries by working with Michigan Medicare providers to embrace evidence-based medicine across all settings (hospital, physician office, nursing home, and home health)

·         Protect the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services and goods that are reasonable and medically necessary and are provided in the most appropriate setting

·         Protect beneficiaries (approximately 1.5 million beneficiaries in Michigan) by addressing individual complaints, such as beneficiary complaints and provider-based notice appeals

MPRO also provides consultative services, medical and utilization review, and data analysis to federal agencies, state Medicaid and public health agencies, healthcare facilities, and private health plans and other third party payers. Based in Farmington Hills, Michigan, MPRO’s staff consists of physician reviewers, clinical quality improvement and patient safety experts and statisticians. MPRO provides expertise across the continuum including; hospital, nursing home, home health, physician office and managed care settings.