CMS’ 2014 Quality Improvement Organization (QIO) Program report describes its new program structure, highlights its recent statistical achievements, offers examples of its successes, and outlines its five-year goals for the QIO program.
According to the report, the new structure of the QIO program follows a functional model with two types of QIOs: (1) Quality Innovation Network-QIOs (QIN-QIOs); and (2) Beneficiary and Family Centered Care-QIOs (BFCC-QIOs). This dual function structure separates the regulatory complaint review process from quality improvement work. For example, 14 regional QIN-QIOs work with providers, community partners, and beneficiaries on initiatives to improve patient safety, reduce harm, engage patients and families, improve clinical care, and reduce health care disparities. Two BFCC-QIOs manage all beneficiary complaints and appeals across the nation.
According to CMS, recent achievements from the program include:
- nearly $1 billion in cost savings from combined QIO programs;
- recruitment of 1,826 professionals potentially impacting 4.1 million beneficiaries;
- 53 percent reduction in central line-associated blood infections;
- 20 percent improvement in controlling blood sugar levels among participants screened;
- 5,021 nursing homes participating in a national collaborative;
- 6,250 beneficiaries in 981 nursing homes now restraint-free;
- 3,374 bed sores prevented or healed in 787 nursing homes; and
- 44,640 potential adverse drug events prevented.
Examples of success
CMS offered examples of its successes in the areas of better health, better care, lower cost, hospital engagement, using data from the Centers for Disease Control and Prevention (CDC) for prevention, and the Million Hearts® initiative.
- Better health. CMS highlighted the following better health efforts: (1) using faith-based organizations to promote heart health; (2) maximizing electronic health record system benefits for physicians and patients; (3) the Everyone with Diabetes Counts program going national; and (4) partnering with local colleges to train bilingual diabetes educators.
- Better care. Highlights of better care initiatives included: (1) collaboration with hospitals to reduce health care-associated infections (HAIs); (2) creating a replicable model for sustainable quality improvement; (3) enabling peer-to-peer learning and sharing for nursing home staff; (4) using new processes to prevent adverse drug events; and (5) tools for improving discharge communications and fewer drug errors.
- Lower costs. Initiatives to lower costs included: (1) implementation of agreed-upon quality measures; (2) the use of value-based payment and quality reporting models; and (3) helping providers in multiple care settings to navigate quality reporting requirements.
- Hospital engagement. CMS highlighted the cooperation of the Washington State Hospital Association and Qualis Health Quality Innovation Network, the QIN-QIO for Idaho and Washington, which are jointly tackling common health concerns, including reducing hospital readmissions and HAIs.
- CMS highlighted a 2014 CDC pilot program with seven QIOs to reduce catheter-associated urinary tract infections.
- Million Hearts campaign. CMS reported that QIN-QIOs are adding a community level connection to the Million Hearts initiative to prevent one million heart attacks and strokes by 2017.
The QIN-QIO five-year goals focus on the patient and a commitment to achieving better care, better health, and lower costs. They include:
- improving cardiac health and care disparities;
- increasing diabetes awareness and education;
- improving prevention through meaningful use of health information technology;
- reducing HAIs;
- improving nursing home resident care and safety;
- reducing antipsychotic drug use in long-term care facilities; and
- using a community approach to fully support coordination of care and the reduction of preventable hospital admissions and readmissions.