CMS launches next phase of new Quality Improvement Program

CMS launches next phase of new Quality Improvement Program

The Centers for Medicare & Medicaid Services (CMS) today awarded additional contracts as part of a restructuring the Quality Improvement Organization (QIO) Program to create a new approach to improve care for beneficiaries, families and caregivers. QIOs are private, mostly not-for-profit organizations staffed by doctors and other health care professionals trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care.

The new contracts being awarded to fourteen organizations represent the second phase of QIO restructuring. The awardees will work with providers and communities across the country on data-driven quality initiatives. These QIOs will be known as Quality Innovation Network (QIN)-QIOs.

QIN-QIO projects will be based in communities, health care facilities and clinical practices.  They will drive quality by providing technical assistance, convening learning and action networks for sharing best practices, collecting and analyzing data for improvement.  The U.S. Department of Health and Human Services’ (HHS) National Quality Strategy (NQS) and the CMS Quality Strategy provide the framework for the contracts along with the companion, recommendations, and priorities.

Specifically, each QIN-QIO will work on strategic initiatives such as reducing healthcare associated infections, reducing readmissions and medication errors, working with nursing homes to improve care for residents, supporting clinical practices in using interoperable health information technology to enable the exchange of essential  health information to improve the coordination of care, promoting prevention activities, reducing cardiac disease and diabetes, reducing health care disparities and improving patient and family engagement.  QIN-QIOs will also provide technical assistance for improvement in CMS value based purchasing programs, including the physician value based modifier program.  

As a result of the changes, some hospitals and providers will now work with a different QIO than in the past. The new QIN-QIO contracts were competitively awarded. The restructured program will continue to ensure that the entire country participates in strategic initiatives and that local practices are considered.

“Quality Improvement Organizations have always supported beneficiaries with a nationwide infrastructure dedicated to improving the quality of health care”, said Patrick Conway, Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer.  “Under this new QIO program structure, I am excited about the positive impact QIOs will have, working in collaboration with national and local organizations.  CMS and QIOs are building momentum in transforming healthcare delivery by supporting learning systems, improving efficiency and value, and achieving better health outcomes for beneficiaries.”

The first phase of the restructuring – which CMS announced on May 9, 2014 –allows two Beneficiary and Family-Centered Care (BFCC) QIO contractors to perform the program’s case review and monitoring activities separate from the quality improvement activities performed by QIN-QIOs. The two BFCC-QIO contractors are Livanta LLC and KePRO. They will be responsible for ensuring consistency in the review process with consideration of local factors important to beneficiaries.

CMS will introduce the program changes with the beginning of its five year, 11th Statement of Work – the QIO contracts cycle – on August 1, 2014.

The QIN-QIO awarded contracts are:

*The Indiana, Puerto Rico, and Virgin Islands awards have not yet been determined.

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