PROVIDENCE – Rhode Island announced plans to rehire Qualidigm, a research and consulting firm in Rocky Hill, Conn., to conduct usage screening and quality-care assessments of health care services provided to the state’s 180,000 Medicaid recipients.
While the terms of the contract have been negotiated and tentatively finalized, it has not yet been signed by both parties, according to David Burnett, a spokesperson with the R.I. Department of Human Services. As a result, both DHS and Qualidigm declined to discuss specific financial details as well as any incentives contained in the contract.
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The pending contract is the third since 2000 that Qualidigm has been awarded by DHS. It is a three-year contract, with two one-year options for renewal. The services being provided through this contract are eligible for 75 percent federal matching funds, according to Burnett.
“We’re very excited to continue to provide final outcome health care improvement to the R.I. Department of Human Services for Medicaid recipients in the state’s 14 hospitals and 86 nursing homes,” said Marcia K. Petrillo, CEO of Qualidigm.
Under the contract, Qualidigm will provide direct screening and utilization review for Medicaid hospital admissions, nurse case management for the “Connect Care Choice Program” and pre-admissions screening and resident reviews for nursing home residents. The Connect Care Choice Program is a primary health care option for adults who have R.I. Medical Assistance program coverage and are 21 years or older.
The reviews are a critical tool for the state’s efforts to manage its Medicaid spending under its Global Medicaid Waiver, Burnett said. “The utilization review function is a person-by-person review of claims,” he said.
At the same time, Rhode Island is also employing a “robust” data warehouse program to look at Medicaid claims across populations, programs and departments, according to Burnett. The data warehouse enables administrators and decision-makers to have the tools to make informed decisions and better coordinate care for Medicaid beneficiaries, according to Gary D. Alexander, secretary of the R.I. Executive Office of Health and Human Services.
