Q&A with Dennis Wagner, Jeneen Iwugo and Dr. Paul McGann: QIO Program in 2018

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Photo of CMS Leadership Dennis Wagner, Jeneen Iwugo and Dr. Paul McGann.
CMS QIO Program Leadership (Front, Left to Right) Dr. Paul McGann, Jeneen Iwugo and Dennis Wagner

QIO News recently sat down with three leaders of the Quality Improvement and Innovation Group (QIIG) within the Centers for Medicare & Medicaid Services’ (CMS) Center for Clinical Standards and Quality (CCSQ): Dennis Wagner, director; Jeneen Iwugo, deputy director; and Dr. Paul McGann, chief medical officer for quality improvement. They shared their perspectives on the Quality Improvement Organization (QIO) Program as it prepares to enter a new year.

Q. What were some of the QIO Program’s biggest achievements this past year?

We are making exceptional progress in several of the Program’s current clinical priority areas. One we’d like to call out is our work in improving nursing home quality. We’ve gotten 12,000 of the nation’s 15,000 nursing homes involved – they are making great progress on both the overall composite measure and the work to reduce inappropriate use of antipsychotic medications.

Using a combination of lean techniques and transparency, we’ve worked closely with Quality Innovation Network-QIOs to overcome some specific recruitment/​enrollment challenges and to achieve our common goals. As a community of practice, we’re embracing quality improvement nationwide and making a national impact by reaching large numbers of providers. Our Strategic Innovation Engine and Special Innovation Projects are helping catalyze new ways of thinking about quality and safety, and demonstrating new dimensions of what can be accomplished in just a couple of years. 

Q. What are your top priorities for the Program in 2018?

Our top priority is generating results. This is our opportunity to show what we can do collectively to meet and exceed our goals. Our second priority is to align our work with the new administration’s priorities, both now and in the future. We know, for example, that the opioid crisis is getting worse. Our current work in targeting adverse drug events (ADEs) aligns with that. QIN-QIOs are seeking to reduce ADE rates – including those of opioids – in 391 communities nationwide, and our Hospital Improvement Innovation Networks’ support contractors are addressing them as well. Burden reduction is another huge priority, both for the administration and the health care system in general since many providers are reporting burnout and feelings of being overwhelmed. We need to address that.

Q. CMS continues to incorporate its Person & Family Engagement Strategy throughout the agency. Can you share any stories about how this has affected your life/​work?

As quality improvement leaders, we’re in the unique position of both developing policy and observing its impact during our personal health care encounters. We all have unique stories of health care experiences we’ve had with family members or loved ones. Those experiences have clarified for us some of the difficulties that patients have in engaging with providers. We need to be more sensitive to patient needs in those situations while also remaining sensitive to provider needs.

One person in particular who’s helped us learn a lot from the patient perspective is Sue Sheridan, our nationally and internationally known expert and patient and family engagement adviser for the past year. The experience of having someone with her background in policy and quality improvement, and her personal experience with patient harm has been eye-opening and truly transformational for us.

At the most personal level, we’ve met people at various points in our lives who have made us staunch advocates of person and family engagement. Patients and families have the greatest stake of anyone in their health care. They’re our customers, and we need to listen to them – we have much to learn about waste and improvement from the patients we serve. We need far more person and family engagement in health care – we need to follow the lead of our administrator, and seek always to put patients over paperwork.”

Q. The QIO Program has made some remarkable progress in the past three years of its ongoing five-year performance period. How do you keep up the momentum?

We have an awesome team of clinicians, experts and influential, highly respected contractors. The techniques we’ve employed to get to this point are working. These techniques are based in strategies and principles that the community as a whole believes in, so we’ll continue to use transparency, continuous improvement, clear bold aims, and the rapid cycle, plan-do-study-act approach to overcome challenges and push toward our common goals. We’re proud of the way the QIO Program is doing this already, and we think we can do even more and even better. Improving health care is meaningful, compelling and important work, so this adds even more oomph to our momentum.

Q. What are some things you look forward to at the 2018 CMS Quality Conference?

We’re excited about working collaboratively across the CMS Quality Networks to generate rapid, demonstrable impact on new and emerging issues like burden reduction and the opioid crisis. We are positioned for greater synergy and impact than ever before. Quality improvement can make a big impact on these challenges, especially now that it is linked to health care payment systems. We will use the conference to connect with each other, align with the administration’s priorities and connect directly with senior leaders like CMS Administrator Seema Verma.

Q. Anything else you’d like to share with QIO News readers?

We would like to extend our thanks to the entire health care community for working hard. We live in exciting times. There continues to be lots of change and dynamism in American health care; the key to the future is to continue to generate results and to align with the needs and priorities of our patients, providers and leadership.