External Quality Review Organization (EQRO)

The Maryland Department of Health is required to evaluate the quality of care provided to Maryland Medical Assistance recipients enrolled in HealthChoice Managed Care Organizations every year.

To ensure the services provided to our members meet established regulations, the Maryland Department of Health uses an outside quality review agency to perform a Systems Performance Review (SPR). The purpose of the SPR is to provide an annual assessment of the structure, process, and outcome of each Managed Care Organization's internal quality improvement program. The SPR reviews the following standards: Quality Improvement, Accountability to the Governing Body, Oversight of Delegated Entities, Credentialing and Recredentialing, Enrollee Rights, Availability and Accessibility, Utilization Review, Continuity of Care, Health Education, Outreach, and Fraud and Abuse.

For more information, click here to review the Maryland Department of Health Systems Performance Review of the Medicaid Managed Care Organizations.

MedStar Family Choice includes all areas of our organization in the quality improvement program to ensure that all services we provide to our members and providers are of the highest level of quality.