CMS' QIO Program: Navigating the New Structure

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During a plenary session at QualityNet, Dennis Wagner, Acting Director of the Centers for Medicare & Medicaid Services’ (CMS) Center for Clinical Standards and Quality; Jeneen Iwugo, Director of CMS’ Division of Beneficiary Healthcare Improvement and Safety; and Teresa Titus-Howard, Director of the CMS Division of End-Stage Renal Disease (ESRD), Population and Community Health, shared recent successes of CMS’ Quality Improvement Organization (QIO) Program and plans for the future.

Notably, the CMS leaders celebrated the QIO Program’s contribution toward helping reduce hospital-acquired conditions by 17 percent nationwide between 2010 and 2013, and for improving care transitions, resulting in nearly $1 billion in savings.

The 25 payment and service delivery models within the CMS Innovation Center's portfolio made a significant impact on the program, they said.

“This represents huge advances and opportunities in health quality improvement," Wagner said. "These models are generating never-before-seen national results, which is a phenomenal achievement—but just a start."

Wagner called upon Quality Innovation Network (QIN)-QIOs and partners to join with CMS in acting boldly and pursuing high standards over the next five years.

"We ask you to set high aims and pursue them," Wagner said. "Together, we know we can achieve better health care at a lower cost."

Iwugo and Titus-Howard highlighted preliminary successes for the newly reorganized QIO Program, as well as plans beyond the transition phase.

QIN-QIOs recently initiated a call for communicating best practices and efficiencies, and embracing a culture of sharing, they said. Moving forward, QIN-QIOs will continue to build partnerships with key stakeholders in each region.

Meanwhile, the Beneficiary and Family-Centered Care (BFCC)-QIOs have set up two full-fledged call centers to respond to beneficiary complaints and quality of care concerns. BFCC-QIOs also have analyzed call data to better understand the quantity and breakdown of calls from beneficiaries and providers, and made necessary adjustments to phone tree systems and the distribution of staff handling different call topics.

Moving forward, BFCC-QIOs will continue to focus on information technology and data collection to guide improved performance and efficiency.

Wagner concluded the plenary with some words of encouragement:

"QIOs are the most unique and powerful force for integration we have,” he said. “Harnessing this huge opportunity for integration requires a mindset of collaboration over competition, of choosing to actively team with partners to prevent duplication of effort, promote synergy and break down the silos in American health care.”