The Centers for Medicare & Medicaid Services’ (CMS) Quality Improvement Organization (QIO) Program helps drive positive change in the nation’s health care system through its data-driven, results-oriented focus. The Program also supports CMS’ ongoing push for greater data transparency. CMS Quality Innovation Network-QIOs (QIN-QIOs) nationwide are setting bold recruitment goals for the health care quality improvement initiatives they are pursuing, and the overall recruitment numbers reported by CMS to date show that the Program is exceeding expectations in terms of reach and participation by health care providers, partners and beneficiaries. Following are some data highlights showing how successful QIN-QIOs’ recruitment efforts have been to date.
Between August 1 and December 31, 2014, QIN-QIOs nationwide harnessed the power of 131 local communities, bringing together hospitals, nursing homes, home health agencies, dialysis centers, senior advocacy agencies, local stakeholders and others in an effort to improve coordination of care and reduce unnecessary hospital admissions and readmissions for Medicare Fee-For-Service beneficiaries. Through these partnerships, QIN-QIOs are reaching 18% of eligible Medicare Fee-For-Service beneficiaries nationwide, far exceeding the 10% goal set by CMS, and potentially impacting 6.8 million Medicare beneficiaries. In coming years, QIN-QIOs will identify additional communities and build more multi-stakeholder coalitions to reduce hospital admissions and readmissions of Medicare beneficiaries.
National Nursing Home Care
As of July 31, 2015, QIN-QIOs recruited more than 7,347 nursing homes nationwide to participate in the National Nursing Home Quality Care Collaborative (NNHQCC). This represents nearly 47 percent of the nursing facilities in the nation that have Medicare certification and substantially exceeds CMS’ initial expectation to recruit 6,000 homes. Collaborative I began on April 1, 2015 and will continue its work for 18 months. Collaborative II will begin in April 2017, at which time the QIO Program aims to recruit 75 percent of all Medicare-certified nursing homes nationwide – approximately 11,000 homes overall. The NNHQCC seeks to engage nursing homes in peer-to-peer learning at the state and local level, use best practices as provided in an NNHQCC Change Package based on high-performing nursing homes, and in keeping with the Collaborative Aim statement, work to ensure that every nursing home resident receives the highest quality of care.
As of July 31, 2015, QIN-QIOs recruited 3,164 physician offices using certified electronic health records (EHRs) for Physician Quality Reporting System (PQRS) reporting of cardiac measures – a 238% increase over the national recruitment goal submitted in April 2015. QIN-QIOs also recruited 1,914 home health agencies (an 11% increase over the national recruitment goal) and 844 local/state/national partners and stakeholders (a 13% increase over the national recruitment goal) for participation in cardiac health initiatives. Additionally, 13,628 individuals representing 5,332 home health agencies – 43% of all Medicare-certified agencies nationwide – are active in the QIO Program’s Home Health Quality Improvement (HHQI) initiative, which seeks to improve the quality of care that home health patients receive.
QIN QIOs are working across communities in every state to improve medication safety and to prevent adverse drug events (ADEs) for Medicare beneficiaries at high risk for an ADE or who are on three or more medications – specifically diabetic, opioid and anticoagulant medications. By July 31, 2015, QIN-QIOs had exceeded CMS’ expectations by recruiting the following for medication safety initiatives: 454 hospitals with 280 associated pharmacies and 571 pharmacists; 172 nursing homes with 37 associated pharmacies and 101 pharmacists; 1,185 total pharmacies across all care settings; 2,529 total pharmacists; and 1,254 total recruited health care entities/settings. QIN-QIOs are working with providers and practitioners to improve surveillance of ADEs and so far have screened just over three million beneficiaries.
Everyone with Diabetes Counts
Diabetes self-management education (DSME) is a proven intervention for empowering persons with diabetes to take an active role in controlling their disease. QIN-QIOs — in their current performance period lasting from August 1, 2014 to July 31, 2019— have launched a new national initiative to help patients and families, providers and communities address this serious chronic condition and its disproportionate effects on racial/ethnic and rural populations. As of July 31, 2015, QIN-QIOs recruited 825 participating providers for the Everyone with Diabetes Counts (EDC) program, exceeding CMS’ national target goal for that period by 25 percent. QIN-QIOs also successfully helped 3,464 beneficiaries complete DSME classes as of that date, exceeding CMS’ national target goal for that period by 2.2 percent. Finally, QIN-QIOs obtained clinical data for 251 beneficiaries as of that date, exceeding CMS’ national target goal for that period by 4.7 percent.