Which entity is responsible for reviewing managed care organization health care?

The correct choice is the External Quality Review Organization (EQRO). EQROs are tasked with performing independent reviews of managed care organizations (MCOs) to evaluate the quality, timeliness, and access to health services provided to enrollees. This includes analyzing performance metrics, conducting audits, and ensuring that MCOs adhere to state and federal regulations regarding quality of care.

The EQRO's primary role is to enhance accountability and transparency in managed care services, ensuring they meet established standards for care and patient outcomes. This independent oversight helps to protect consumer interests and promotes continuous improvement in health care delivery systems.

While the National Committee for Quality Assurance (NCQA) does set standards for managed care organizations and accredits them based on quality metrics, it does not perform the independent review function that EQROs provide. QAPI (Quality Assurance and Performance Improvement) is more of an internal process used by organizations to improve the quality of services and is not an entity that provides external evaluations of managed care. QISMC (Quality Improvement System for Managed Care) provides frameworks for quality assessment but does not fulfill the specific review role attributed to EQROs.