Quality Improvement Programs

The CMS iQuality Improvement and Innovation Group (iQIIG) oversees a portfolio of interconnected Quality Improvement Programs designed to enhance healthcare quality and outcomes for Medicare beneficiaries across diverse populations. Services provided by QIOs are at no cost to eligible healthcare providers and beneficiaries.

The Quality Improvement Programs include:

1. The ESRD (End Stage Renal Disease) Network Program supports patients with End Stage Renal Disease by serving as care navigators and quality improvement partners, working to increase home dialysis and transplant rates, reduce hospitalizations, and empower patient and family choice in kidney care decisions. Complementing the Networks, ESRD KHARES (Kidney Health Analytics & Responsive Emergency Support) functions as the national coordination hub for all 18 ESRD Networks, providing centralized emergency management infrastructure, data analytics, community engagement, and educational resources to drive consistent kidney care quality nationwide. 
2. The OPS (Opioid Prescriber Support) Program initiative provides national outreach and education to eligible providers to promote safe opioid prescribing practices and to spread knowledge of non-opioid pain management therapies.
3. The Quality Improvement Organizations (QIO) Program: As one of the largest federally funded quality improvement programs in the country, CMS directs Quality Improvement Organizations (QIOs) to collaborate with healthcare providers nationwide to improve outcomes for Medicare beneficiaries. In 2025, CMS launched the 13th Scope of Work to support healthcare quality improvement and the Secretary's Make America Healthy Again (MAHA) initiative. 

The QIO Program has two core contract functions: healthcare quality improvement support and case review. Both functions are carried out through three initiatives, including:

• The QIN-QIO (Quality Innovation Network- Quality Improvement Organizations) Program partners directly with nursing homes, hospitals, and physician offices to address disease prevention, quality and patient safety, chronic conditions management, behavioral health, emergency preparedness, care coordination, and workforce challenges to improve the quality and safety of care for people with Medicare. (May 2025 – May 2030)
• The BFCC (Beneficiary and Family Centered Care) QIO Program helps people with Medicare and their families exercise their right to high-quality health care. They do this by managing quality of care concerns, conducting immediate advocacy and reviewing appeals of discharge or decisions to end Medicare-covered services. (May 2024 – April 2029)
• The AIAN (American Indian Alaska Native) QIO Program works directly with Indian Health Service (IHS),  tribally managed, and urban Indian facilities (hospitals, nursing homes and clinician offices) to improve the quality of health care for people with Medicare who are American Indian or Alaska Native to address preventive health and wellness, patient safety, and behavioral health. (January 2025 – May 2030)

Nationally, the QIO Program partners with leading organizations like the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and many others. QIOs also work with state, local, and tribal agencies, engaging them as partners in learning and action networks as well as improvement collaboratives to drive impactful, large-scale positive efficiently.

Together, these programs reflect iQIIG’s unified mission to advance quality, patient empowerment, and data interoperability across the full spectrum of Medicare and delivery.

Quality Evaluation and Improvement Contracts Descriptions

CMS carries out important evaluation and improvement activities for public benefit and services programs to ensure Medicare and Medicaid beneficiaries receive cost-effective, high-quality, evidence-based services, consistent with the principle of beneficence. CMS and the quality improvement contractors use patient identifiable information for program planning and outcomes assessment. Although the primary purpose of the Quality Improvement Organizations (QIO) program is to improve healthcare quality, evaluation activities sometimes produce generalizable knowledge (which might be interpreted by some as meeting the definition of human subjects’ research).

All of CMS’s QIO program contractors comply with strict privacy protection standards to safeguard identifiable information, including those related to the Federal Information Security Management Acts of 2002 and 2014, the Health Insurance Portability and Accountability Act, and regulations specific to the Quality Improvement Organization program (42 CFR 480).
 

The following QI project listing includes only QI projects that potentially qualify as human subjects research but qualify for an exemption and the corresponding common rule exemption for each such QI project:

• The work conducted under the contract, Network of Quality Improvement and Innovation Contractors (NQIIC) Program Monitoring and Evaluation Contract, for the 13^th Statement of Work (13SoW). This contract collects data, conducts analysis, and develops reports to monitor progress toward 13SoW program goals and impact of program outcomes. This activity studies, evaluates, and improves a public benefit program and thereby falls under the 45 CFR 46.104(d)(5) exemption from human subjects research requirements.

For quality improvement projects that include human subjects research and do not meet the criteria for a common rule exemption, CMS will comply with Institutional Review Board (IRB) requirements.