Performance Improvement Project Validation

To learn more, contact:
Jenny Klink
Vice President of Managed Health and Long-Term Care
1-800-362-2320 or 1-608-274-1940, ext. 8216

MetaStar evaluates performance improvement projects (PIPs) that are required by the Wisconsin Department of Health Services (DHS) as specified in its contract with managed care organizations (MCOs) and health maintenance organizations (HMOs), in order to comply with federal regulations.

The purpose of a PIP is to assess and improve the processes and outcomes of health care provided by an MCO or HMO.  PIP validation is a mandatory EQR activity and determines whether  a MCO’s /HMO’sperformance improvement project is designed, conducted, and reported in a methodologically sound manner.

To evaluate the standard elements of a PIP, the MetaStar team used the methodology described in CMS EQR Protocol 3, Validating Performance Improvement Projects (PIPs), A Mandatory Protocol for External Quality Reviews (EQR), Version 2.0.

MetaStar reviews and provides a written evaluation report to both DHS and the MCO/HMO for each PIP submitted under the contract period. During the contract year, at the direction of or in collaboration with DHS, MetaStar may also review projects for pre-approval and provide technical assistance to MCOs/HMOs conducting PIPs.