Quality Talk

Jean Moody-Williams, RN, MPP, is responsible for the Quality Improvement Organization Program and the End Stage Renal Disease Networks. In this role, she supports the CMS mission to improve the effectiveness, efficiency, economy and quality of services delivered to Medicare beneficiaries. Ms. Moody-Williams received her Bachelor of Science in Nursing from Hampton University and a Master of Public Policy and Management from the University of Maryland, College Park. In addition to her experience working at two QIOs, she is a former health system quality improvement director.

“QIOs have a unique perspective on local needs and can serve as a catalyst for accomplishing national [healthcare quality] improvement goals.”

You bring a unique perspective to CMS with your QIO experience and clinical training as a registered nurse. Share with us your background and how it is guiding you in your current role.

As director I can draw upon many aspects of my past work and educational experience. My position as a registered nurse provided me the opportunity to understand the diverse challenges that beneficiaries face and the important role I can play as a clinician in helping to achieve outcomes. That’s what draws me to this role. I am humbled by the extraordinary trust patients place in us.

I’ve also enhanced my clinical experience with several management and health policy roles at the Medicare QIOs for Michigan and Pennsylvania and the Maryland Health Care Commission. Most recently, I served as the Director of the Division of Quality, Evaluation and Health Outcomes for [CMS’] Center for Medicaid and State Operations (CMSO) and was responsible for leading quality improvement efforts for the Medicaid and Children’s Health Insurance Programs. My overall experience has allowed me to gain a deep understanding and a unique perspective on the health care system from every angle.

What is your vision for the QIO Program? How does this lead to better care for Medicare beneficiaries?

The QIO Program plays an important role in bringing harmony to the quality improvement effort across the country. QIOs are unique in that there is a presence in every state, a local infrastructure that can be leveraged. QIOs have a unique perspective on the local needs and can serve as a catalyst for accomplishing national [healthcare quality] improvement goals.

The emphasis in the initial phase of the 9th SOW has been on capturing data about how well QIOs are working with providers to get involved in improving the quality of care, and then once they are recruited, how well are providers and QIOs working together to make a positive impact on the health of patients. New health information technology holds promise to greatly improve coordination of care and the availability of quality improvement data. The question is, “What do you do with these data and how useful is it?” My vision is that the QIO Program is the method by which we effect improvements in healthcare quality: we see immediate changes in the providers with whom we partner, and we can learn from those partnerships to extend healthcare quality improvement changes to all providers. In the future, things will evolve and providers will be much more savvy users of data. As we get more real-time data, clinicians will have instant and accurate health information about a patient during the care process. We will have to develop new strategies to use this real-time data. Ultimately, the root of the QIO Program is protecting Medicare’ beneficiaries’ access to high-quality healthcare.

While definitions of what constitutes a reformed health system vary, the fundamental tenets of patient-centered healthcare are widely accepted. What impact does the QIO Program aim to have in a reformed health system?

QIOs stand ready to help implement, monitor and evaluate whatever proposals are approved in a reformed healthcare system. Our focus is to achieve measurable, evidence-based goals. The basic tenets of the QIO Program are aligned with the future direction of the healthcare system, regardless of what policy changes may be in the works. This includes improving patient safety, emphasizing prevention and healthy living, increasing equity of care, reducing the high costs of care, improving care and its efficiency and preserving Medicare Trust Fund money.

QIOs are already promoting the use of healthcare information technology. QIOs are also at the forefront of care coordination. No matter who’s steering the health discussion, we’re consistent with the key areas of health systems change. CMS was insightful in taking this approach with the QIO Program when developing the last SOW.

The Medicare QIO Program is nearing the midpoint of the 9th SOW. What impact have QIOs demonstrated at this time?

QIOs have demonstrated the ability to serve as accountable organizations that can implement performance goals. Now there are data to back it up—we can now measure how much performance improvement QIOs have accomplished. There are not many other public organizations that can say the same. One example where we see success already in QIOs’ ability to engage and recruit providers to tackle the difficult quality issues outlined in the SOW. QIOs have the credibility to engage community partners and providers. They are collaborating with thousands of providers. I can confidently say that QIOs have met recruitment goals without exception.

Now that we know that QIOs can successfully engage providers to commit to healthcare quality improvement, it’s time to analyze outcomes as compared to baseline to measure what gains we’ve made in improving the health of our beneficiaries. It would be premature of me to speculate, but I am very optimistic.

What types of collaborative opportunities are available for QIOs and partners that can expand and enhance QIOs' capabilities and the expertise they offer to healthcare providers?

There are many more parties involved in quality improvement efforts than any time before. As a country, we have to be strategic in our improvement efforts so as not to be duplicative or inefficient. There is plenty of work to be done but we really have to do a better job of coordination and collaboration. We have to focus on our national priorities. QIOs are no strangers to collaboration and are already working together in the areas of controlling healthcare-acquired infection, reducing healthcare disparities, and adopting health IT at the national and local level with other stakeholders.

It’s already time for us to look ahead to the 10th SOW. What do you see the 10th SOW looking like? How do you see the criteria or clinical topics shaping up?

It is fortunate that we took the time to restructure the QIO Program with our 9th SOW; those efforts have paid off. We are optimistic that many of the thematic areas in the 10th SOW are consistent with the views of public, Congress, the Administration and providers, with some built-in flexibility. You can expect us to refine what’s worked, eliminate what hasn’t and continue to focus on the delivery of value, attribution, oversight and improving the health of Medicare beneficiaries.

I can say that there will not be many surprises. We will be focusing on getting the best value out of government dollars and looking at streamlining contracting processes. There will also be opportunities for stakeholders to provide input In the 10th SOW. We expect to have something that we will all be proud of.

Ms. Moody-Williams is available at OCSQBox@cms.hhs.gov