Quality Talk

Dr. Conway is chief medical officer of the Centers for Medicare and Medicaid Services (CMS) and director of the Agency’s Office of Clinical Standards and Quality (OCSQ). Previously, Dr. Conway served as director of hospital medicine at Cincinnati Children’s Hospital, where he was responsible for improving a clinical division and the measurement and quality of care for a $1.5 billion healthcare system. He also has served as chief medical officer for planning and evaluation at the United States Department of Health and Human Services (DHHS) and was a White House Fellow assigned to DHHS’ Agency for Healthcare Research and Quality from 2007 to 2008.

"At the end of the day, quality improvement takes place in communities. The QIO Program is uniquely positioned to be successful in this mission."

You bring a unique perspective to OCSQ with your experience as a pediatrician and a hospitalist. Tell us a little about your background and how it will guide you in your new role.

Several aspects of my career background have prepared me for my new role at OCSQ. As a pediatrician and practicing physician, I have direct patient experience on the front lines of care. As a hospitalist, I’ve learned to become a care coordinator. My background as a health systems researcher has taught me how to effectively evaluate health systems. And while at Cincinnati Children's Hospital, I was immersed in quality measurement and improvement initiatives. All of these experiences and the knowledge I’ve gained will serve me well in my new position.

What excites you the most about working with the QIO Program?

What I'm most looking forward to is the opportunity to help catalyze and facilitate quality improvement at the local level. At the end of the day, quality improvement takes place in communities. The QIO Program is uniquely positioned to be successful in this mission.

Under CMS Administrator Dr. Donald Berwick, the QIO Program has a new vision and bold goals. What is different about the way that QIOs will be working with local healthcare providers, Medicare beneficiaries and other healthcare stakeholders?

One chief difference is that Dr. Berwick is asking QIOs to focus on convening local providers, beneficiaries, partners and other stakeholders, and enrolling them in collaborative learning and action networks. By rapidly spreading knowledge and best practices through these networks, we should be able to achieve our goal of making the healthcare system more patient-centered and safe.

You've previously written about the challenges the American health system faces in translating scientific findings into clinical practice that improves patient experiences and outcomes. How will QIOs be a part of the effort to overcome those challenges?

QIOs can play a key role in rapidly implementing new evidence into practices that benefit patients. To cite one example, at Cincinnati Children's Hospital, I was in charge of the Rapid Evidence Adoption Core, which was responsible for identifying new clinical evidence and putting it into practice within 90 days. Typically, this is a process can take 17 years. We had a quality improvement infrastructure in place, as well as a mechanism for scanning for new evidence. We established criteria for selecting which interventions to put into practice, and we identified drivers for rapid adoption of evidence. Perhaps most importantly, we had clear communication with our front line providers about the importance of quickly implementing improvement. In the end, our initiative was successful because we made it easy to apply new evidence through the use of electronic health records, and because of our direct feedback to providers. All physicians want to provide safe and high-quality care for patients. The more that QIOs can help put in place the processes, mechanisms and systems for them to do so, the better off we'll all be.

How does your continued part-time work as a physician inform your work at CMS?

My continued part-time work as a physician helps keep me firmly rooted in the front lines of care and informs my decisions as OCSQ director. Meeting the vital healthcare needs of patients and their families is why we're in this business.

You're a longtime advocate of patient centeredness. How do you define this concept in clinical practice? What can QIOs do to strengthen the application of this concept?

In simple terms, patient centeredness means that every decision that's made and every program that's established is focused on the patient. QIOs can promote this concept by including beneficiaries in quality improvement initiatives, learning and action networks and communications. Listening to the voices of patients and staying focused on their outcomes and experiences are essential for achieving patient centeredness.

As the chief medical officer of one of the world’s largest insurers, you have a unique opportunity to shape the American government’s healthcare quality improvement agenda. What is your vision for realizing the Administration’s new goals and priorities for health quality improvement?

The foundation for all of our health quality improvement initiatives is the Three-Part Aim and OCSQ's five principles: seeking input and listening to patients' and providers' needs; working collaboratively across CMS, the government and nation; striving for continual improvement via learning networks; measuring the most important components of health quality and aligning incentives; and always doing what's best for patients and families. When faced with challenging health care decisions, I've found that returning to the concept of patient centeredness has helped me make the best possible choice.

Anything else you’d like QIO News readers should know? 

As a final note, I'd like to make it clear that our role at OCSQ is to help QIOs support providers and patients at the local level. We can no longer afford to view QIOs as contractors, nor should they describe themselves as such. We're partners in our common effort to transform the healthcare system.