the new qin qio contract10/24/2014 1 the new qin – qio contract november 10, 2014 presented by:...
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10/24/2014 1
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