The QIO Program’s Evolving Approach to Reducing Racial and Ethnic Health Disparities

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Timeline of QIO Program's Health Disparities Efforts

[Note: Portions of this article were excerpted from Hidden in Plain Sight: CMS Quality Improvement Organizations and the Elimination of Racial and Ethnic Health Disparities,” prepared in June 2014 by the Delmarva Foundation for Medical Care, which today is part of the Atlantic Quality Innovation Network.]

According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death for people of most racial and ethnic minorities in the United States. Moreover, certain minority groups are at particularly high risk of developing type 2 diabetes. Often driven by cultural, social, environmental, community and individual factors, these disparities account for a disproportionate burden of disease, disability and death for a sizeable portion of the U.S. population.

Disparities in health care access, quality and outcomes associated with race, ethnicity and poverty first gained national attention in 1985 with the publication of the U.S. Department of Health and Human Services (HHS)’ Secretary’s Taskforce Report on Black and Minority Health. A number of federal and state health entities, as well as national initiatives to reduce disparities have been established since then, including the Centers for Medicaid & Medicare Services’ (CMS) Quality Improvement Organization (QIO) Program.

The QIO Program’s role has evolved over the past 40 years, steadily expanding its capacity to partner with providers and other health care stakeholders to identity gaps, improve access to care and overcome cultural and language barriers to health equity.

Since 2000, the QIO Program has specifically targeted improvements in care for African Americans, Asians, Pacific Islanders, American Indians, Alaska Natives, Hispanics and beneficiaries enrolled in both Medicare and Medicaid. Rural populations were added as a target population in 2000.

In 2012, CMS established a Disparities National Coordinating Center (DNCC) to support QIOs’ efforts to reduce race and ethnic health disparities for Medicare beneficiaries. The DNCC helped connect QIOs with other disparities reduction initiatives administered by the U.S. Department of Health and Human Services (HHS). It also analyzed disparities related to Medicare quality priorities, including adverse drug events, nursing home quality, hospital-acquired infections, cardiac health and diabetes. And it developed and distributed useful tools and resources based on best practices.

The DNCC also helped support a couple of successful Special Innovation Projects (SIP) that were conducted by the QIO Program from 2011-2014. These projects were community-based interventions targeting racial, ethnic and geographic disparities.

Two of these SIPs became the cornerstone for the QIO Program’s current efforts to achieve health equity. Today, Quality Innovation Network-QIOs (QIN-QIOs) nationwide are using the Everyone with Diabetes Counts program to help Medicare beneficiaries with type 2 diabetes learn to manage their disease. They also are partnering with Million Hearts® to help providers develop programs for beneficiaries to improve their cardiac health. Both of these initiatives are aimed at reducing racial, ethnic and geographic disparities

While major gaps in health disparities persist in the United States, the QIO Program and its national and community partners are well positioned to make advancements in health equity over the coming years.