Quality Improvement Organizations

What is the QIO Program?

Led by the Centers for Medicare & Medicaid Services (CMS), the Quality Improvement Organization (QIO) Program is one of the largest federal programs dedicated to improving health quality for people with Medicare. Signed into law in 1982 with Title XI of the Social Security Act, it is an integral part of the U.S. Department of Health and Human Services’ (HHS) strategy to protect and strengthen equitable access to high quality and affordable health care. Core functions of the QIO Program include:

• Using data to track health care quality improvements at the local level;
• Protecting the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services and goods that are reasonable and necessary and that are provided in the most appropriate setting; and
• Protecting beneficiaries by expeditiously addressing individual complaints, such as beneficiary complaints; provider-based notice appeals; violations of the Emergency Medical Treatment and Labor Act (EMTALA); and other related responsibilities as articulated in QIO-related law.

The QIO Program serves people with Medicare, health care providers and communities. All initiatives are designed to improve health care quality, access, value and equity for people with Medicare.

QIO Program initiatives include:

• Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs)
• Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs)
• Hospital Quality Improvement Contractors (HQICs)
• The American Indian Alaska Native Healthcare Quality Initiative (AIANHQI)
• The Opioid Prescriber Safety & Support initiative (OPSS)

QIO Program priorities:

The QIO Program’s data-driven initiatives bring stakeholders together at the local, community and tribal levels to:

• Improve behavioral health outcomes and decrease opioid utilization and misuse
• Improve chronic disease management
• Improve care coordination and the quality of care transitions
• Increase immunizations against influenza, pneumonia and COVID-19
• Increase patient safety
• Decrease the impact of COVID-19 and improve infection control

Why does CMS have QIOs?

CMS relies on the QIO Program to improve the quality of health care for all people with Medicare. Furthermore, BFCC- and QIN-QIOs are required under Sections 1152-1154 of the Social Security Act. The QIO Program is an important resource in CMS’s effort to improve quality and efficiency of care for people with Medicare. Throughout its history, the QIO Program has been instrumental in advancing national efforts to motivate providers in improving quality, and in measuring and improving outcomes of quality.

QIO Reports to Congress

CMS is required to publish a Report to Congress every fiscal year that outlines the administration, cost, and impact of the QIO Program.  See the links in the "Downloads" section to read our most recent fiscal year Report to Congress.

Also in the "Downloads" section, read our special Report to Congress in response to the Institute of Medicine's 2006 study on the QIO Program, Medicare's Quality Improvement Organization Program: Maximizing Potential.  CMS' response to that report outlines improvements, based on an extensive CMS review and recommendations from the Institute of Medicine, to strengthen Medicare's oversight and evaluation of the QIO Program to better meet the future needs of beneficiaries and health care providers.