Fact Sheets

CMS SETS BOLD NEW CARE IMPROVEMENT GOALS FOR QUALITY IMPROVEMENT ORGANIZATION PROGRAM

OVERVIEW

In August 2011, the Centers for Medicare & Medicaid Services (CMS) marked a bold, new direction in improving health care services to Medicare beneficiaries by launching a series of projects that will take place within the Quality Improvement Organization (QIO) Program between now and July 2014.

The new set of projects serves as one more tool in the fight against poor, uncoordinated, and unsafe care in America’s nursing homes, physician offices, hospitals, and other care settings. Earlier this year, the Administration launched a new collaborative effort, “Partnership for Patients: Better Care, Lower Costs,” which aims to reduce hospital-acquired conditions by 40 percent by 2013 and save an estimated 60,000 lives in the next three years. In addition, this initiative aims to reduce hospital readmissions by 20 percent by 2013, preventing rehospitalization of 1.6 million patients.

The QIO program will work side-by-side with the Partnership for Patients to help meet these bold new goals.

BACKGROUND

The QIO Program is an integral part of the U.S. Department of Health and Human Services’ National Quality Strategy to transform America’s healthcare system. The CMS administers the program through a national network of 53 independent QIO contractors located in each of the 50 states, the District of Columbia, Puerto Rico and the Virgin Islands.  It serves as the largest federal program dedicated specifically to improving healthcare quality at the community level.

As a major force and trustworthy partner for the continual improvement of health and health care for all Americans, QIOs work with patients, providers and practitioners across organizational, cultural and geographic boundaries to spread rapid, large scale change. The work that QIOs perform spans every setting in which health care is delivered – even the critical transitions between those settings.

NEW PROJECTS TAKE AIM AT HEALTH CARE DELIVERY, STATUS, AND COSTS

The QIO program focuses on three aims: better patient care, better population health, and lower health care costs through improvement. providing better care for individuals, and lowering the cost of health care. QIOs are well positioned to bring together health quality stakeholders, build the will for change and support collaborative learning and improvement.

As part of this effort, QIOs will contribute to bold, national goals, like a 40 percent reduction in hospital-acquired conditions. Hospital-acquired conditions are largely avoidable conditions such as central line-associated bloodstream and catheter-associated urinary tract infections, as well as falls and pressure ulcers, which occur at care facilities. Through large-scale learning networks, QIOs will accelerate the pace of change and rapidly spread best practices. Improvement initiatives will encourage innovation, respond to community needs, and lead the way to patient-centered care by including an active role for Medicare beneficiaries.

QIOs will collaborate with health care providers that commit to improvement, no matter where they fall along the quality spectrum: leaders, the mainstream, and those who need technical assistance. These partnerships will strive to reconfigure health care processes to make them safer and more patient-centered. The QIO Program’s charter for leading change will include the following tasks:

• Continue to review beneficiary complaints, as well as advocating beneficiaries and their families to be meaningfully involved in QIO improvement and prevention activities, not just with complaints and appeals;
• Use evidence-based change packages and other improvement tools in partnership with CMS and the Patient Safety and Clinical Pharmacy Services Collaborative from the Health Resources & Services Administration to improve patient safety and health outcomes;
• Work with nursing homes to reduce pressure ulcers;
• Reduce central-line bloodstream infections using Comprehensive Unit-based Safety Program (CUSP) methodology;
• Boost population health by improving use of electronic health records for care management to increase preventive services like flu and pneumococcal immunizations, and colorectal and breast cancer screenings; and
• Assist in the goal of reducing readmissions within 30 days of discharge by 20 percent over three years by changing processes of care at community levels, including hospitals, home health agencies, dialysis facilities, nursing homes, and physician offices.

NEW PROJECTS RE-ENGAGE QUALITY STAKEHOLDERS EVERYWHERE

In addition to beginning these new projects, QIOs will change the way they work with their local communities. Embracing the idea of “no boundaries” as a prerequisite for system-wide change, QIOs will work to tear down organizational, cultural and geographic “silos” that keep care from being the best it can be.  QIOs will do this by opening their projects to providers at all levels of clinical performance who make a commitment to improvement. They will also launch large-scale learning and action networks to accelerate the pace of change and rapidly spread best practices. Improvement initiatives include collaborative projects, online interaction and peer-to-peer education.

CMS invites all health care providers and health quality stakeholders–including patients and their families–to be a part of the QIO Program’s new improvement initiatives. To express an interest, contact one of the local QIOs. A directory of QIOs, as well as more information about the QIO Program, is online at www.cms.gov/qualityimprovementorgs.