Past Work

QIO Program 11^th SoW (2014-2019)

Quality Improvement Organizations (QIOs) performed the 11th Statement of Work (SoW) between 2014 and 2019. SoW initiatives were designed to reach health care providers, community partners and people with Medicare and their families in areas that served vulnerable and rural populations. The SoW empowered Medicare beneficiaries with knowledge and skills to prevent or manage chronic conditions such as diabetes and heart disease; guided nursing homes to design effective quality improvement projects to improve resident care; averted preventable hospital admissions and readmissions through collaborations with community coalitions; and assisted physician practices, hospitals and health systems to leverage their data to meet their quality improvement goals.  

QIN-QIOs completed the 11th SOW contracting period in July 2019 with some important contract results that include the following: 

• Nearly 77,600 underserved and at-risk Medicare beneficiaries were educated through Diabetes Self-Management Education and Support programs, leading to sustained and statistically significant reductions in glycated hemoglobin test (HbA1c) percentages. 
• QIN-QIOs engaged more than 13,000 clinicians to increase the identification of depression and alcohol use disorder among fee-for-service (FFS) Medicare beneficiaries. 
• About 905,250 nursing home residents across the country avoided antipsychotic medications. 
• Nearly 8,150 nursing homes achieved a quality measure composite score of six or less, impacting the lives of nearly 692,700 residents. This surpassed the target of 5,804 nursing homes, reaching over half of the nursing homes in the U.S. 
• More than 5,700 outpatient settings implemented all four of the Centers for Disease Control and Prevention (CDC) Core Elements of Outpatient Antibiotic Stewardship. 
• Nearly 719,840 and 116,100 hospital admissions and readmissions, respectively, were avoided among fee-for-service (FFS) Medicare beneficiaries in recruited communities. These avoided admissions and readmissions would have accounted for more than $9.7 billion in Medicare spending. 
• For the Quality Payment Program (QPP) performance year 2017, 98.5 percent of providers that received technical assistance from a QIN-QIO participated in the QPP Program, compared with the national participation rate of 91 percent. Clinicians who received technical assistance from a QIN-QIO obtained higher final Merit-based Incentive Payment System (MIPS) scores than those who did not. 
• QIN-QIOs conducted nearly 32,250 assessments for the Transforming Clinical Practice Initiative in collaboration with the Practice Transformation Networks and Support and Alignment Networks.

QIO Program 10^th SoW (2011-2014)

Quality Improvement Organizations (QIOs) performed the 10^th Statement of Work (SoW) between 2011 and 2014.

The 10th SoW was structured to: reduce disparities in access and quality for priority populations, increase use of health information technology, reduce adverse events related to health care- acquired infections, increase care efficiency by promoting value within the health system, and improve the quality of life for patients nearing the end of life by alleviating pain and other distressing symptoms. Among many important results:

• QIOs worked alongside national efforts such as CMS’s Partnership for Patients initiative to reduce harm and readmissions in hospitals. By working with QIOs, communities across the country prevented over 95,000 beneficiaries from being admitted to the hospital, and averted over 27,000 readmissions, resulting in improved coordination of care and nearly one billion dollar in savings, although the savings estimated are not solely attributable to QIOs .
• QIOs worked with Intensive Care Units (ICU) and other hospital units to reduce Health care-Associated Infections (HAI) and ensure transparency in reporting, noting a 53 percent relative improvement in reduced Central Line Associated Blood Stream Infections (CLABSI) among engaged facilities.
• QIOs supported efforts to achieve a 34.4 percent reduction in pressure ulcers for high risk nursing home residents.
• Through their work in over 400 communities across the country, QIOs reported more than 44,600 adverse drug events avoided among Medicare beneficiaries.
• QIOs reviewed more than 200,000 cases for quality of care concerns at the request of beneficiaries, families, and referral agencies.

View the full summary of results in the “Downloads” section below.

QIO Program 9^th SoW (2008-2011)

Quality Improvement Organizations (QIOs) performed the 9^th Statement of Work (SoW) between 2008 and 2011.

The 9th SoW focused on improving preventive care, improving patient safety, reducing hospital readmissions by improving transitions of care between hospital and post-hospital care, improving disparities in diabetes care and preventive services, improving testing and care for chronic kidney disease, protecting beneficiaries from substandard health care, investigating and resolving beneficiary appeals and complaints, and assisting hospitals in reporting quality measures. The QIO Program work resulted in many improvements to beneficiary care and outcome measures, including implementation of 140 system-wide quality improvement interventions and more than 1,900 quality improvement activities for 98% of confirmed quality of care concerns. The QIO Program saw greater reductions in pressure ulcers and physical restraint use in nursing homes, and helped hospitals make significant progress towards pay for performance.

View the independent evaluation of the 9^th SoW and the FY2011 QIO Program Annual Report to Congress in the “Downloads” section below.

QIO Program 8^th SoW (2005-2008)

Quality Improvement Organizations (QIOs) performed the 8^th Statement of Work (SoW) between 2005 and 2008.

The 8^th SoW focused on quality improvement for nursing homes, home health agencies, hospitals, and physician practices through organizational “transformations” intended to produce more rapid, measurable improvements in care. The QIOs worked intensively with subsets of individual providers to help them redesign care processes and make internal systemic changes, such as the adoption and implementation of health information and communication technologies. The 8^th SoW contract also included case review and other beneficiary protection activities as well as the Hospital Payment Monitoring Program (HPMP).