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QIO Program Boosts Medicare Care Coordination, Patient Safety

The Medicare Quality Improvement Organization (QIO) Program has helped providers improve care coordination, patient safety, and population health management.

care coordination and patient safety

Source: Thinkstock

By Jennifer Bresnick

- The CMS Quality Improvement Organization (QIO) Program saw a number of successes in 2016, according to the initiative’s annual report, including significant gains in care coordination, behavioral healthcare, chronic disease management, and patient safety for Medicare beneficiaries.

Both arms of the program, including the Quality Innovation Network-QIOs (QIN-QIOs) and Beneficiary and Family Centered Care QIOs (BFCC-QIOs) made progress towards meeting CMS’ six primary quality strategy goals, which center on reducing avoidable harm, lowering costs, promoting communication across the care continuum, and improving relationships with patients, their providers, and their communities.

“In 2016, QIN-QIOs were especially successful in achieving impactful results in the areas of care coordination, diabetes care and nursing home care,” the report says. “BFCC-QIOs exceeded established targets for the timely review of beneficiary complaints and yielded flexible, hands-on resolutions.”

QIN-QIOs also worked on a series of other population health management efforts, including raising immunization rates among adults in rural regions of South Carolina.

In one case study included in the brief, CMS details the partnership between the Atlantic Quality Innovation Network (AQIN) and the South Carolina Department of Health and Environmental Control (DHEC).  The two entities forged a coalition of nearly 40 state and community organizations to increase immunization rates.

READ MORE: How to Get Started with a Population Health Management Program

“We knew from the start that community outreach would be the key to success, so we incorporated immunizations into our other quality improvement work and engaged partners that helped attract new collaborators,” said Melinda Postal, Quality Specialist at AQIN-South Carolina.

From August of 2014 to March of 2015, 29 out of the 40 participating sites saw an increase in adult influenza vaccination rates.  In 2015, all involved counties recorded an uptick in adult pneumonia vaccinations, as well.

The coalition is continuing to expand its efforts by holding regular community events and coordinating with Walgreens to promote vaccinations and other services for senior citizens in rural areas.

Additional milestones, projects, and achievements highlighted in the report include:

  • Six regional QIN-QIOs recruited more than 5000 practices and 150 inpatient psychiatric facilities (IPF) for a behavioral health program that screens patients for depression and alcohol use disorder.  The project produced a 0.8 percent reduction in admissions to IPFs.
  • The QIN-QIO network engaged more than 350 communities covering over 23 million Medicare beneficiaries in an initiative to reduce preventable readmissions by improving care coordination and transitions of care.  Patients avoided more than 24,350 preventable readmissions in 2016.
  • 2150 practices took part in a diabetes self-management education project that reached 27,850 patients.  More than 3300 educators received training that allowed them to teach chronic disease management skills to patients in nearly a dozen languages, including English, Spanish, French, Russian, Mandarin, Cantonese, Korean, Vietnamese, Swahili, Hmong and Tagalog.
  • More than 1100 hospitals came together to improve patient safety and reduce healthcare-associated infections.  The organizations reduced central line-associated bloodstream infections by 16.5 percent and C. difficile infections by 1.5 percent.
  • Medication safety efforts at more than 3700 facilities resulted in the screening of 1.2 million beneficiaries at high risk for an adverse drug event (ADE). 
  • BFCC-QIOs conducted more than 29,000 review for quality are care concerns, identifying 3850 opportunities for quality improvement across a number of healthcare provider types.  Sixteen percent of concerns were related to not establishing an appropriate treatment plan for patients.
  • Higher Weighted Diagnosis-Related Group (HWDRG) reviews by BFCC-QIOs produced $20 million in cost savings, double the savings of the program’s first year.
  • QIN-QIOs and BFCC-QIOs worked together to perform and report on more than 730 successful quality improvement initiatives.
  • The National Nursing Home Quality Care Collaborative, which includes close to three-quarters of all nursing homes in the US, saw a 21 percent reduction in the use of antipsychotic medication.

In addition to recruiting thousands of new providers for care coordination, chronic disease management, and population health initiatives, the fourteen regional QIN-QIOs are now also serving as technical assistance resource centers for the Quality Payment Program (QPP). 

READ MORE: Patient Safety Improvements Could Cut Avoidable Deaths by 50%

Groups of 16 or more physicians can take advantage of education and expert advice about the program.

“The QIN-QIOs’ technical assistance includes, but is not limited to: reporting and submission support, leveraging the use of Certified Electronic Health Record Technology, selecting quality measures, and identification of resources,” the report says.

More than 750 hospitals and 1650 practices representing over 26,000 individual clinicians have already taken advantage of the technical assistance options. 

Over 1150 other facilities, including critical access hospitals, cancer hospitals, and psychiatric facilities, have also sought information and guidance from a QIN-QIO in order to prepare for MIPS or an Alternative Payment Model (APM).

The Transforming Clinical Practice Initiative (TCPI) is taking a complementary approach by helping to prepare clinicians for participation in APMs such as qualifying accountable care organizations and bundled payment programs.

READ MORE: Using Risk Scores, Stratification for Population Health Management

“QIN-QIOs partner with the Practice Transformation Networks in their region to assess the progress of participating practices through the five phases of practice transformation,” CMS explains. “The QIN-QIOs assess progress by conducting baseline and ongoing assessments.”

The entities have completed more than 3500 baseline assessments and 1900 follow-ups to guide providers towards comprehensive practice transformation and reimbursement reform, and expect more participation as the QPP takes hold in the industry.


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