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The New QIN – QIO Contract

November 10, 2014

Presented by:

Adrienne Mims, MD MPH VP, Chief Medical Officer

What is our end goal….

Support a continuously evolving network of

dedicated and committed experts in quality

improvement, working together in partnership

with multiple entities, patients and families to

improve health care, support the creation of

healthy people in healthy communities and

lower costs through improvement.

“To change a nation...”

QIO Approach

CMS asked for input early….

Example of Inputs Considered:

► Secretary’s Priorities (e.g. National Quality Strategy, Million Hearts,

Partnership for Patients, HAI High Priority Goal)

► National Action Plan to Prevent Health-care Associated Infections

► National Prevention Strategy

► HHS Action Plan to Reduce Racial and Ethnic Health Disparities

► Federal Health IT Strategic Plan

► AHRQ Comprehensive Unit Based Safety Program

► HRSA Consultation in Rural Health and Adverse Drug Events

► IOM Reports: Medicare QIO Program and Better Care at Lower Costs

► GAO and OIG Reports

► Focus Groups with Patients, Families and Providers of Care

Messages from the Field ► Support Beneficiaries and their families so that they can fully participate in

their health and wellness decisions.

► Facilitate the organization of local communities and build momentum for change within the community.

► Support the development of learning communities.

► Measure and review often, while responding quickly to data.

► Use principles of idealized design, constantly questioning and testing assumptions.

► Conduct and apply operations research principles and reducing waste using Lean techniques.

► Support advance quality improvement and value activities such as value stream mapping, health system economics, using continuous improvement tools.

► Serve as a facilitator and coach in transformation activities.

► Help with “sense making” in a growingly complex health care market place.

Formula for the 11th SOW

Keeping the Patient at the Center

CMS and HHS Priorities

Statutory Requirements

Evidence and Input from National and

Local Leaders in the Field

Experience and Data from 10th SOW and

Previous Contracts

11th SOW - August 2014 - July 2019

Major Changes for the QIN – QIO Work

► CMS separated medical case review from quality

improvement work creating two separate structures:

– Medical case review to be performed by Beneficiary Family

Centered Care Quality Improvement Organizations (BFCC-QIOs).

– Quality improvement and technical assistance QIOs to be

performed by Quality Innovation Network Quality Improvement

Organizations (QIN-QIOs).

► Two BFCC-QIOs are organized to cover the nation

► QIN-QIOs are regional and cover 2 to 6 states.

► QIO contract cycle extended from 3 to 5 years

► Value Incentives and Quality Reporting Centers created.

11 SOW QIN-QIO Map

QIN – QIOs Key Roles

1. Results Oriented

A Multi-state & Local Change-agent Champion

2. Learning & Action Networks

A Facilitator of Learning & Action

3. Technical Assistance A Teacher & Advisor

4. Communication A Highly-effective

Communicator and

Trusted Partner

QIN – QIO 11th SOW

Better Health:

► Improving Cardiac Health and Reducing Cardiac Healthcare Disparities

► Reducing Disparities in Diabetes Care: Everyone with Diabetes Counts

► Improving Prevention Coordination through Meaningful Use of

HIT and Collaborating with Regional Extension Centers

Better Care:

► Reducing Healthcare-Associated Infections in Hospitals

► Reducing Healthcare Acquired Conditions in Nursing Homes

► Coordination of Care

Lower Cost:

► Quality Improvement through Value-Based Payment, Quality Reporting,

Physician Feedback Reporting Program

► Quality Improvement Initiatives

Learning and Action Network

Websites to save to favorites!

http://qioprogram.org

http://www.alliantquality.org

This material was prepared by GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services (CMS), an

agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 11SOW-GMCFQIN-QIO-14-12