Delmarva Foundation for Medical Care, Inc.

Improving Health Services and Programs

DF logo_wotag_stacked_2C_4_07Delmarva Foundation has experience with both the public and private sectors creating safe, effective, and efficient systems of care since 1973. Beginning as the designated Professional Standards Review Organization (PSRO) for the Eastern Shore in 1974, Delmarva Foundation has gone on to oversee a variety of state-level and national projects that have contributed to our reputation as a national leader in health care quality improvement.

Medicare Atlantic Quality Innovation Network (AQIN) Member

2LadiesInKitchenOn August 1, 2014 Delmarva Foundation became part of the Atlantic Quality Innovation Network (AQIN) serving the District of Columbia, which provides targeted technical assistance and engages providers and stakeholders in improvement initiatives through numerous Learning and Action Networks. AQIN also serves as an information hub to monitor data, engage relevant organizations, facilitate learning and sharing of best practices, reduce disparities and elevate the voice of the patient.

Quality Improvement for Persons with Developmental Disabilities (DD)

The primary focus of the DD (primarily intellectual/developmental disabilities but also some other disabilities such as head and spinal cord injuries) program is to provide quality assurance and/or quality improvement expertise to state programs supporting individuals with intellectual or developmental disabilities (I/DD). Our activities are a piece of each state’s overall quality management approach to meet oversight requirements established by state legislatures, the Center for Medicare and Medicaid Services (CMS) and in the case of Georgia, a settlement agreement with the Department of Justice (DOJ). Contract activities differ in each state but may include:

  • Person Centered Reviews-interviews of individuals receiving services, observations of the service delivery environment, as well as corresponding record reviews
  • Provider Reviews-employee interviews and record reviews
  • Follow Up with Technical Assistance
  • Data Analysis and Reporting
  • Quality Improvement Council Facilitation
  • Training and Education

External Quality Review

Delmarva Foundation’s External Quality Review (EQR) activities are focused on reviewing and monitoring the quality provided by Managed Care Organizations (MCOs) offering services under the Medicaid Program. Delmarva Foundation is the External Quality Review Organization (EQRO) for five states. In support of our state customers Delmarva Foundation:

  • Validates performance improvement projects (PIP)
  • Validates plan performance measures
  • Reviews to determine the plan’s compliance with state standards for access to care; structure and operations; and quality measurement and improvement.
  • Validates encounter data
  • Administers and validate consumer and provider surveys on quality of care
  • Calculates additional performance measures
  • Conducts additional PIPs
  • Conducts studies on quality focused on a particular aspect of clinical or nonclinical services at a point in time.

Utilization Management

Our primary mission is to protect the fiscal and clinical integrity of health care systems by using our expertise, innovative approaches, and extensive experience in utilization management and quality improvement. Our main focus is to deliver service that exceeds our customer’s expectation. We provide Utilization Management Service in support of the Medicaid program in both the District of Columbia and the State of Maryland.