A CMS 50th Anniversary Q&A with Patrick Conway

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Dr. Patrick Conway, CMS
Dr. Patrick Conway, CMS

Patrick Conway, MD, MSc, is the Centers for Medicare & Medicaid Services’ (CMS) Acting Principal Deputy Administrator and Deputy Administrator for Innovation and Quality, and CMS Chief Medical Officer. As the CMS Acting Principal Deputy Administrator and CMS Chief Medical Officer, Conway is responsible for overseeing the programs that serve the over 100 million Americans that access health care services through Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and the Marketplace. He and the CMS team focus on improving health outcomes, access and affordability while reducing health disparities and combatting health care fraud.

As the Deputy Administrator for Innovation and Quality, Conway leads the Center for Clinical Standards and Quality (CCSQ) and the Center for Medicare and Medicaid Innovation (CMMI) at CMS. CCSQ is responsible for all quality measures for CMS, value-based purchasing programs, quality improvement programs in all 50 states, clinical standards and survey and certification of Medicare and Medicaid health care providers across the nation, and all Medicare coverage decisions for treatments and services. The CMS Innovation Center is responsible for testing numerous new payment and service delivery models across the nation.

Previously, Conway was Director of Hospital Medicine and an Associate Professor at Cincinnati Children's Hospital. Other relevant experience includes previous work as the Chief Medical Officer at the U.S. Department of Health and Human Services (HHS) in the Office of the Assistant Secretary for Planning and Evaluation.

In 2014, he was elected to the Institute of Medicine (IOM). He has published articles in publications such as the Journal of the American Medical Association, the New England Journal of Medicine, Health Affairs and Pediatrics, and given national presentations on topics including health care policy, quality of care, comparative effectiveness, hospitalist systems and quality improvement. He is a practicing pediatric hospitalist and was selected as a Master of Hospital Medicine from the Society of Hospital Medicine. He has received the HHS Secretary’s Award for Distinguished Service. He completed his pediatrics residency at Harvard Medical School's Children's Hospital Boston, graduated with High Honors from Baylor College of Medicine and graduated summa cum laude from Texas A&M University.

Q. CMS is widely perceived as a national leader in improving health care quality. What have been some of the agency’s most significant and recent accomplishments in the area of health quality improvement?

A. Many of those accomplishments came about via the QIO Program. I’ll call out a few specifically. First, the QIN-QIO work with nursing homes that has led to improvements in areas like pressure ulcers, restraint usage and antipsychotic drug usage. Second, the QIN-QIOs’ work in reducing unnecessary admissions and readmissions to hospitals. Third, the QIN-QIOs’ and Partnership for Patients’ activities in the area of patient safety. In the last three years, we experienced a 17 percent reduction in harm, corresponding to about 50,000 lives saved, 1.3 million unnecessary patient harms avoided and $12 billion in cost savings. Finally, our 2015 Impact Assessment of Quality Measures Report showed that 95 percent of 119 publicly reported performance rates across seven quality reporting programs improved from 2006 to 2012. QIN-QIOs helped support many of these quality measures.

Q. What are the next steps or priorities for the agency in its pursuit of the goals outlined in the CMS Quality Strategy?

A. We have now moved to the implementation and execution phase of the strategy, so we have teams and affinity groups working on various dimensions of it. We are identifying measures to track our internal and external progress toward our national quality goals. What is exciting to me is that we are executing on our own strategy.

Q. In recent years, CMS has made patient-centered care the core of its work and incorporated patient and family engagement strategies throughout its quality improvement activities. What impact is this having, and what additional patient-centered changes can Medicare beneficiaries expect to see over the coming years?

A. Our focus on patient and family engagement is a foundational building block that is outlined in the CMS Quality Strategy. I will provide a couple of tangible examples to show the impact. In our quality measurement work, patients are involved in the actual development and implementation of quality measures; they bring in the view of what is most important to them. In our patient safety work, patients are helping drive quality improvement by actively participating in or guiding patient safety committees. As part of our QIN-QIO and Hospital Exchange Network activities, patients are directly involved in improvement teams and are generating some of the best ideas for improvement. I think this trend will continue and, in fact, accelerate. We are focused on engaging patients in every step of the health care process.

Q. CMS’ Quality Improvement Organization (QIO) Program has been in existence for 33 years, making it one of the agency’s longest established programs focused on health quality. What distinguishing roles do you see it playing in health care delivery transformation over the coming years?

A. The QIO Program is the foundational quality improvement program for Medicare. It has an essential role in health care delivery transformation. More specifically, it is operating within every state and territory, and collaborating directly with clinicians and communities to improve health care. There is no better mechanism in place to drive health care delivery transformation. I view the QIO Program as an integral part of CMS’ health care delivery reform strategy.

Q. How can the QIO Program and the Center for Medicare and Medicaid Innovation (CMMI) best support and collaborate with each other in testing and spreading effective strategies for achieving higher quality health care?

A. There are several ways that the QIO Program and CMMI can collaborate. First by making sure they link up within CMMI’s Learning and Diffusion Group. That group is leading a learning collaborative involving model learning participants. QIN-QIOs also can collaborate within some specific innovation model groups that are part of CMMI. In our State Innovation Models Group, for example, we are working with 38 states and territories on comprehensive delivery system reform. Another model is our Transforming Clinical Practices Initiative (TCPI). We are currently reviewing applications for TCPI awards, including some submitted by QIN-QIOs, so they may end up doing the work directly. Across the board, we will want QIN-QIOs supporting the work of TCPI. Last, but not least, is a model which hasn’t been announced yet – our Accountable Health Communities Model – for which we will make investments in communities. QIN-QIOs have tremendous experience in that area. We would love to engage more with QIN-QIOs.

Q. Anything else you would like QIO News readers to know?

A. CMS is trying to build an internal culture of learning and continuous improvement. We encourage everyone to take that approach – to become a true learning organization that is continually improving. We are asking ourselves questions like, Do we have the right employee training and how can we improve our processes?” CMS is making significant investments in training in such areas as LEAN, and we encourage all BFCC- and QIN-QIOs, and providers to consider making bigger investments in training as well. I would like to thank all QIOs and providers focused on quality improvement and encourage them to continue to try to make improvements faster. We are making significant progress toward the goals of better care, smarter spending and healthier people. Now is the time to accelerate our progress toward those goals.