As the Quality Improvement Organization (QIO) Program 11th Scope of Work (SoW) comes to an end, leaders at the Quality Improvement and Innovation Group (QIIG) within the Centers for Medicare & Medicaid Services (CMS) Center for Clinical Standards and Quality (CCSQ) are celebrating the last five years of health care quality improvement. In this special issue of QIO News, QIIG Director Dennis Wagner and Chief Medical Officer for Quality Improvement Dr. Paul McGann reflect on the progress made so far — and the evolution they see ahead — for the QIO Program.
Q: What were some of the top priorities for the QIO Program over the past five years, and how were they addressed?
Paul McGann: In the 11th SoW, we split up the two core functions of the QIO Program — quality improvement and case review — forming Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) and Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs), respectively. The BFCC-QIO work focused on better understanding what patients are facing when navigating the Medicare system. Three QIN-QIO initiatives that stand out include improving the health status for communities, making care safer for all patients and providing better care at lower costs.
Dennis Wagner: Speaking to how those priorities were addressed, in just the last year, QIN-QIOs helped more than 47,000 people with Medicare complete Diabetes Self-Management Education (DSME) courses, recruited more than 5,000 practices to increase the number of alcohol and depression screenings, and helped 75% of people with Medicare using tobacco to get cessation counseling. Beyond that, BFCC-QIOs conducted more than 40,000 reviews for quality of care concerns and identified more than 23,000 opportunities for quality improvement across a variety of health service providers.
These numbers go a long way in showing how dedicated the QIN-QIOs and BFCC-QIOs are to bettering health quality for people with Medicare.
Q: Can you share some feedback, experiences and/or stories you’ve heard along the way as you’ve spoken with people with Medicare, providers, caregivers, etc. in your travels and conversations?
PM: Over the last five years, we’ve had the privilege of meeting so many wonderful stakeholders from within the QIO Program, as well as providers, patients and dedicated advocates. One thing we’ve heard over and over again is that the DSME training has been a huge success, with tens of thousands of people with Medicare getting the help they need to successfully manage their diabetes.
For example, Health Services Advisory Group, the QIN-QIO for Arizona, California, Florida, Ohio and the U.S. Virgin Islands, was tasked with educating nearly 16,000 people with Medicare about diabetes self-management. This was an enormous stretch goal for them, but they ended up exceeding it by 60%, educating, in total, 25,368 people with Medicare.
DW: I agree with Dr. McGann. I recently met with atom Alliance, the QIN-QIO serving Alabama, Indiana, Kentucky, Mississippi and Tennessee, and their DSME courses garnered rave reviews. I was able to visit a few churches in Memphis and saw how the people there were so grateful for the training, saying it has improved their quality of life substantially. This is real work — it isn’t just window dressing.
We’ve also heard a lot about QIN-QIO work around chronic kidney disease (CKD) and end stage renal disease (ESRD). Precious McCowan, an ESRD patient and member of the ESRD Network 14 Patient Advisory Council (PAC), spoke at — and, in fact, opened — the 2019 CMS Quality Conference, sharing with more than 3,000 health care leaders how patient-centered care has been integral to her quality of life.
Her work and the work of so many others across the QIO Program bore fruit on July 10 when President Trump, along with Center for Medicare & Medicaid Innovation Director Adam Boehler, CMS Administrator Seema Verma and U.S. Department of Health and Human Services Secretary Alex Azar, launched a series of national initiatives to increase kidney health. These efforts are aimed at improving patient involvement, empowerment and choice through human-centered design, as well as increasing the number of life-saving and life-enhancing kidney transplants.
Q: What will be some top priorities for the QIO Program over the next five years?
PM: Five main categories of priority work have been identified for the QIO Program 12th SoW:
- Behavioral health outcomes, including targeting the opioid crisis;
- Patient safety;
- Chronic disease management, incorporating diabetes efforts, the Million Hearts® cardiovascular disease initiative, and the new Advancing Kidney Health work on CKD and ESRD;
- Care transitions, and;
- Nursing home care, concentrating on the very important problem of abuse of nursing home residents.
DW: We also want to focus on cross-cutting priorities to address the needs of small, rural and vulnerable populations, and put an even greater emphasis on patient and family engagement. It’s essential that we take those five main priorities and make sure they’re all implemented within our communities.
Q: What are you most looking forward to seeing accomplished?
DW: I think there are two big areas that I’m excited about: transparent sharing of results and teaming up to form powerful partnerships. We’ve done a lot of this over the past five years, and there’s plenty of room for more. By sharing data and results, the QIO Program gets a much broader view of what’s happening across the country — whether it’s rates of kidney disease or diabetes training success stories, we can all learn from each other. And teaming with trusted local organizations is crucial. They know their populations better than anyone and can help QIN-QIOs and other advocacy groups target people and priorities that will best help the community. Partnering makes us all stronger.
PM: In terms of clinical focus areas, I’m happy to see how our greater emphasis on chronic disease can help those suffering better understand how to manage their conditions. We’ll specifically be targeting cardiovascular disease — continuing the incredible work being done with the Million Hearts® initiative — as well as diabetes prevention and kidney disease/ESRD. With regard to CKD, we want to help people with Medicare identify the disease early or even prevent it when possible. For those with ESRD, we want to work to get them a kidney transplant quickly.
Q: Any other thoughts you’d like to share?
DW: The last five years have seen incredible success for the QIO Program and I believe that the work we’ve done will live on for years to come. QIN-QIOs have educated and recruited providers and patients across the country to improve the quality of health care, and BFCC-QIOs have helped people with Medicare exercise their right to high-quality care. While there is always more work to do, we are so proud of what has been accomplished and thankful for the QIN- and BFCC-QIOs’ hard work and dedication over the past half-decade.