Focused Studies

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 conducts focused studies; an optional external quality review activity that focus on a particular aspect of clinical or nonclinical services as a point in time. Below are focused activities conducted for Wisconsin DHS.

Care Management Reviews

MetaStar assesses the care management functions and practices of managed care organizations (MCOs) and health maintenance organizations (HMOs) by reviewing member records. CMR is an optional activity. MetaStar develops the methodology and tools for conducting and reporting results, in collaboration with the Wisconsin Department of Health Services (DHS).

The purpose of this review is to evaluate the following processes and outcomes of care delivered by the MCO/HMO and its providers for Family Care, Family Care Partnership, Program of All-Inclusive Care for the Elderly (PACE), and Supplemental Security Income (SSI) enrollees. The review is conducted at the direction of DHS and includes the following focus areas:

  • Timely and comprehensive member assessment
  • Service coordination
  • How well service plan goals reflect the enrollee’s stated desires and preferences
  • Whether services furnished or coordinated are consistent with the nature and severity of the enrollee’s disability and stated desires and preferences
  • Whether services are delivered in a timely and effective manner

Information about care management practices is gathered using a variety of methods and tools approved by the Wisconsin Department of Health Services (DHS), such as a review of documentation in the member record/chart and discussions with, or surveys of, management and/or interdisciplinary care teams. The resulting report focuses on key areas of care management practice; assessment, service planning, service coordination and delivery, and participant-centered focus as well as strengths and overall opportunities for improvement.

Healthy Birth Outcomes

As part of the Wisconsin Department of Health Services initiative, MetaStar conducts a Medical Home Review for BadgerCare Plus members who are at high risk of a poor birth outcome and are participating in the Medical Home program. For this purpose, these women include:

  • Women with a chronic condition that could negatively affect their pregnancy (e.g., diabetes, severe hypertension)
  • Women with a previous poor birth outcome (e.g., preterm infant, low birth weight, high birth weight, or infant death)
  • Women under 18 years of age

MetaStar also conducts a review of care for any BadgerCare Plus HMO enrollee in who has a poor birth outcome, defined as:

  • Baby born pre-term (less than 37 weeks gestation)
  • Baby born at low-birth weight (under 2500 grams)
  • Baby dies within 28 days