named programs · 5 · from sources
What they call their work
End-Stage Renal Disease (ESRD) Network Program
Manages four ESRD networks providing quality oversight, education, and support services to dialysis facilities and patients across multiple states
External Quality Review Organization (EQRO)
Conducts annual reviews of Medicaid managed care organizations' quality of care and performance measures
Federal Independent Dispute Resolution (IDR) Program
Conducts independent reviews of payment disputes between providers and payers under the No Surprises Act
Project Firstline
Implements CDC-led infection prevention and control training for frontline healthcare staff in dialysis centers across New York State
Quality Innovation Network-Quality Improvement Organization (QIN-QIO)
Provides quality improvement services to Medicare providers in CMS Region 1 (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Puerto Rico, and the U.S. Virgin Islands)
activities · 7 groups
What they do
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Health Information Exchange Support 2 activities
- Independent dispute resolution for healthcare payment disputesProvides independent payment dispute resolution services between healthcare providers and health plans for out-of-network services under the No Surprises Act as a federally certified Independent Dispute Resolution Entity (IDRE), and operates the Federal Independent Dispute Review Program.
- Independent review of managed care coverage disputesConducts external, independent reviews of managed care coverage disputes as an Independent Review Organization (IRO) accredited by URAC, serving in 16 states and the District of Columbia.
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Program Evaluation and Impact Research 1 activity
- Applied research on healthcare delivery transformationEstablishes and conducts applied research studies through the Center for Program Evaluation to assess the impact of healthcare delivery transformation programs.
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Program Monitoring & Evaluation 1 activity
- Healthcare quality evaluation in correctional settingsConducts evaluations of healthcare quality in the New York State prison system.
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Podcast and Radio Production 1 activity
- Healthcare quality podcast productionProduces the Quality Watch podcast to share information on healthcare quality improvement and data insights.
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Infection Control in Long-Term Care 1 activity
- Infection prevention training for dialysis centersImplements CDC-led Project Firstline to deliver infection prevention and control training to frontline healthcare workers in New York State dialysis centers.
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Healthcare Delivery Networks and Coalitions 1 activity
- Medicare Quality Innovation Network-QIO operationsOperates as the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) in the Northeast (Region 1) and Mid-Atlantic (Region 2), implementing quality improvement initiatives across 13 states, Puerto Rico, the Virgin Islands, and the District of Columbia under CMS contracts, including the 13th Statement of Work.
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Uncategorized 3 activities
- ESRD Network Program managementOperates the IPRO ESRD Network Program through four regional networks, providing oversight for end-stage renal disease care across the U.S., managing a $20 million annual budget, and recognized for innovations such as the Kidney Transplant Compare Application.
- External quality review for managed care plansConducts mandatory and optional external quality review activities for over 150 managed care plans nationwide to support state clients in monitoring and improving performance, including NCQA-licensed HEDIS Compliance Audits performed by certified auditors and trained consultants.
- Healthcare quality evaluation and technical assistanceDesigns, develops, and implements quality improvement and assessment activities for Medicare and Medicaid programs, including utilization review, data collection, analysis, validation, special studies, consulting services, and emergency preparedness tools like the Healthcare Emergency Hub mobile application.
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financials · form 990 · fy2023
revenue
Total revenue$105.56M
Contributions & grants$00%
Program service revenue$103.53M98%
Investment income$1.83M2%
Other revenue$202K
expenses
Total expenses$94.56M
Program expenses81%
Admin / overhead19%
Fundraising0%
Salaries & benefits$50.66M
Grants paid out$28K
Largest expense lineCompensation
balance sheet
Total assets$101.04M
Cash$57.50M
Investments$3.38M
Liabilities$39.78M
Net assets$61.25M
Liquid reserves7.7 mo
5 years on record · 2019–2023 · YoY revenue +26.9%
leadership · form 990 part vii · fy2023
Who runs it
paid leadership · 25
| Name | Title | Hours/wk | Compensation |
|---|---|---|---|
| THEODORE O WILL | CHIEF EXECUTIVE OFFICER | 42 | $877K |
| HARRY M FEDER SR VICE | PRESIDENT & COO THRU JAN 2024 | 40 | $691K |
| CLARE BRADLEY POLLET MD | SR. VICE PRESIDENT & CMO | 40 | $549K |
| EDISON A MACHADO JR MD | SR. VICE PRESIDENT & CSO | 40 | $455K |
| ALAN WOGHIN | SR. VICE PRESIDENT & CFO | 40 | $437K |
| HERMAN A JENICH | SR. VICE PRESIDENT & CD & AD | 40 | $400K |
| RICHARD A ALFIERI | VICE PRESIDENT & CIO | 40 | $381K |
| VIRGINIA A HILL | VICE PRESIDENT, MANAGED CA | 40 | $380K |
| TIERRE A JEANNE-PORTER | ASSOC. VICE PRESIDENT | 40 | $327K |
| PATRICIA J GAGLIANO MD | VICE PRESIDENT, HEALTHCARE | 40 | $323K |
| JENNIFER N EDWARDS | ASSOC. VICE PRESIDENT | 40 | $319K |
| SUSAN E CAPONI | VICE PRESIDENT, ESRD | 40 | $308K |
| MATTHEW W ROBERTS | VICE PRESIDENT, STATE HEAL | 40 | $303K |
| MONTY M BODENHEIMER MD | MEDICAL DIRECTOR | 32 | $293K |
| FRANK N MATTHES | ASSISTANT VICE PRESIDENT | 40 | $260K |
| DAVID A ZONA | SR. DIRECTOR | 40 | $250K |
| JOHN A FRIEDMAN MD | PRESIDENT | 1 | $11K |
| PAUL J ROWLAND | TREASURER | 0 | $8K |
| STUART B ALMER | DIRECTOR | 0 | $6K |
| RAYMOND D SWEENEY | VICE PRESIDENT | 0 | $6K |
| LOIS WAGH | DIRECTOR | 0 | $5K |
| ROBERT J PANZER MD | SECRETARY | 0 | $4K |
| WILLIAM E SHANAHAN | DIRECTOR | 0 | $4K |
| BARBARA J BRECKENRIDGE | DIRECTOR THRU JUN 2024 | 0 | $3K |
| NIESHA NEAL | DIRECTOR THRU JUN 2024 | 0 | $3K |
relationships · 32
Who they work with
- American Association of Kidney Patients Partner — Recognized IPRO’s ESRD Network 9 with the 2024 Dominick Gentile, MD Memorial Award for its Kidney Transplant Compare Application.
- CMS Government — Contractor for the Quality Innovation Network-Quality Improvement Organization program in New York and New Jersey
- CMS Government — Primary federal agency awarding contracts to IPRO for Medicare Quality Innovation Network-Quality Improvement Organization services.
- CMS Government — Primary federal agency contracting IPRO to operate as the Medicare QIN-QIO in two regions.
- CMS Government — Primary federal agency contracting with IPRO to implement the Medicare QIN-QIO program in two regions.
- CMS Government — Primary government agency awarding contracts to IPRO for Medicare quality improvement work.
- CMS Government — Primary government agency awarding contracts to IPRO for the QIN-QIO program.
- CMS Government — Primary government partner and funder under the 13th Statement of Work for QIN-QIO services in Regions 1 and 2.
- CMS Government — Primary government partner and funder under the Medicare QIN-QIO program contracts.
- Centers for Disease Control and Prevention Government — Leads Project Firstline, which IPRO is implementing in New York State dialysis centers.
- Centers for Medicaid & Medicare Government — Federal agency referenced for information on the No Surprises Act rules.
- Centers for Medicare & Medicaid Services Government — Awarded IPRO a contract to lead the QIN-QIO program in the Northeast Region.
- Centers for Medicare & Medicaid Services Government — Awarded IPRO contracts to serve as the Medicare QIN-QIO for the Northeast and Mid-Atlantic regions.
- Centers for Medicare & Medicaid Services Government — Primary government agency partner under the QIN-QIO and IDR programs
- Department of Labor Government — Federal agency that certified IPRO as an Independent Dispute Resolution Entity under the No Surprises Act.
- Department of Treasury Government — Federal agency that certified IPRO as an Independent Dispute Resolution Entity under the No Surprises Act.
- Federal payers Government — Contracted entity for health care review and quality improvement services
- Health Level Seven International Network — IPRO is a member of this standards development organization for electronic health information exchange.
- Healthcentric Advisors Partner — Collaborates with IPRO on Medicare QIN-QIO initiatives in the Northeast and Mid-Atlantic regions.
- National Association of Health Data Organizations Network — IPRO is a member organization focused on improving healthcare through health data use.
- National Association of Independent Review Organizations Coalition — IPRO employees hold leadership roles in NAIRO committees, including Technology/AI/Cybersecurity and Legislative Committees.
- National Committee for Quality Assurance Government — NCQA-licensed to conduct HEDIS Compliance Audits
- National Committee for Quality Assurance Partner — Certified IPRO to conduct HEDIS® Compliance Audits™.
- New York State Government — Selected IPRO to implement CDC's Project Firstline in dialysis centers across the state.
- Private payers Partner — Contracted entity for health care review and quality improvement services
- Qlarant Partner — Collaborates with IPRO on Medicare QIN-QIO initiatives in the Northeast and Mid-Atlantic regions.
- State payers Government — Contracted entity for health care review and quality improvement services
- U.S. Department of Health and Human Services Government — Federal agency that certified IPRO as an Independent Dispute Resolution Entity under the No Surprises Act.
- URAC Partner — Accredited IPRO to conduct external, independent reviews of managed care coverage disputes.
- URAC Partner — Accrediting body for IPRO's external, independent review of managed care coverage disputes.
+ 2 more
strategies · 4
How they approach the work
Named approaches extracted from this org’s sources. Where others share an approach, follow it to see the full set of orgs running it.
- Collaborative Multidisciplinary Improvement Networksmethodology: collaborative quality improvementBy convening providers, experts, and stakeholders in multidisciplinary groups, the organization spreads high-impact practices because collective problem-solving and shared learning accelerate adoption of patient-centered improvements across care settings.
- Data-Driven Clinical Quality Improvementmethodology: data-driven quality improvementBy integrating clinical expertise with emerging technology and data solutions, the organization improves healthcare system performance because actionable analytics enable targeted, evidence-based interventions that drive measurable quality gains.
- Evidence-Based Patient-Centered Care Transformationmethodology: evidence-based patient-centered careBy providing no-cost technical assistance to build care teams using evidence-based processes, the organization enables individualized, patient-centered care because frontline adoption of proven models increases care consistency and clinical effectiveness.
- QIN-QIO Model for Healthcare Quality Improvementmethodology: qin-qio_modelBy leveraging the CMS QIN-QIO model through regional contracts, the organization improves healthcare outcomes for Medicare beneficiaries because structured collaboration with providers and data-driven interventions enhance system-wide quality of care.