A New Vision for the Medicare QIO Program

American health care is undergoing extensive, unprecedented change as a result of economic and social challenges. The Centers for Medicare & Medicaid Services (CMS) is acting on this opportunity to transform our health care system into one that consistently delivers better care for patients, better health for populations, and lower costs of care through improvement. The QIO Program is a key part of CMS’ strategy.

Beginning in August 2011, CMS is moving the Program in a new direction. QIOs will shift their focus from conducting smaller, more intensive efforts to leading large-scale initiatives that produce rapid, substantial and widespread improvement in health quality. With bold goals and actionable strategies, the Program will play an important role in implementing the U.S. Department of Health and Human Services’ National Quality Strategy, supporting the patient safety goals of the Partnership for Patients, and improving health care for all Americans.  

CMS has delineated four major aims for the Medicare QIO Program:

• Make care beneficiary- and family-centered by actively engaging patients and their families in decision-making and empowering them to actively participate in managing their own health and health care.
• Improve individual patient care by reducing healthcare-associated infections in hospitals and achieving a 40 percent decrease in healthcare-acquired conditions in nursing homes.
• Integrate care for populations and communities by supporting transitions of care that reduce unnecessary re-hospitalizations.
• Improve health for populations and communities by leveraging the power of electronic health records (EHRs) for better data reporting and care management.

To achieve these aims and contribute to significant, nationwide improvement in health quality, CMS has adopted a strategic approach that supports the formation and convening of learning and action networks; provides critical technical assistance to providers, partners, and health advocates; and which accelerates the pace of improvement via the Care Reinvention through Innovation Spread (CRISP) model.

Shorter Projects, New Clinical Topics

Many QIO improvement projects will be shorter (e.g., 18 months or less), providing CMS with the flexibility to change clinical foci over time as needs and priorities for improvement evolve. To maximize impact, QIOs also will be able to work with providers at every point on the performance spectrum.

To extend the reach of their current, successful nursing home projects, QIOs initially will work with new groups of facilities on pressure ulcer reduction and physical restraint elimination. Over time, improvement initiatives will be introduced on such topics as catheter-associated urinary tract infections and falls.

Improvement initiatives with hospitals will continue to target health care-acquired infections, building on the base that QIOs established by supporting providers in reporting MRSA data and conducting unit-based MRSA projects. Topics will include central line-associated bloodstream infections, catheter-associated urinary tract infections, Clostridium difficile and surgical site infections.

On the community level, QIOs will bring together providers, patients and local leaders to reduce adverse drug reactions and to develop effective systems for coordinating care transitions. For additional information on the QIO Program’s new three-year work plan, please visit: http://tinyurl.com/4xdb4oq.