Primaris wins bid for oversight, review of Missouri Medicaid Managed Care Organizations

COLUMBIA—Columbia-based Primaris Holdings Inc. has received a contract to provide oversight and review of managed Medicaid health plans for more than a half million Missourians.

The one-year, half-million dollar contract with the Missouri Department of Social Services/MO HealthNet Division, is renewable for four additional one-year terms. Primaris, a company with healthcare improvement roots dating back to the early 1980s, also leads healthcare quality initiatives for Missouri’s Medicare beneficiaries.

As the state’s official External Quality Review Organization (EQRO), Primaris will work with managed Medicaid providers Wellcare (Missouri Care), Centene (the parent company of Home State Health), and UnitedHealthcare.

“We are honored the state of Missouri recognizes our ongoing work to achieve healthcare quality improvement,” said Primaris CEO Richard A. Royer. “We look forward to our new partnerships and the opportunity to share and learn from each other’s expertise.”

Managed care is a health care delivery system that aims to maximize efficiency by negotiating rates, coordinating care for better and less costly patient outcomes, and managing use of services. States that operate Medicaid managed care programs must provide for an external, independent review of their managed care organizations. The Centers for Medicare and Medicaid Services (CMS) provides states with matching federal funds for the review costs.

Vickie Alexander, Quality Data Services director at Primaris, noted the company’s long-standing status as a Quality Improvement Organization.

“We know how to look at the data with an eye for identifying opportunities for improvement! We, then help providers to improve delivery of care, thus impacting outcomes” Alexander said.

She said Primaris will provide oversight to ensure that the managed care organizations are compliant with CMS and Missouri Medicaid regulations, and if an improvement plan is needed or is already in place, Primaris will make sure the plans are being carried out.

“Our task is also to educate the health plans about what CMS managed Medicaid protocols are,” Alexander added, “in addition to ensuring access and availability to providers via adequate networks.”

Royer said five firms submitted proposals for the managed Medicaid EQRO bid. The bid-scoring system had a maximum of 110 points, and Primaris scored 110.

“We’re very proud of that,” he said.

As a QIO for the Medicare program in Missouri, Primaris is a subcontractor to TMF Quality Innovation Network-Quality Improvement Organization. As part of the TMF network, Primaris works with healthcare providers to promote patient-centered care, make care safer and more affordable, and improve population health. Some of those initiatives include reducing hospital readmissions, improving diabetes self-management, and improving nursing home care.