QIO Program 11th SOW (2014-2019)
Quality Improvement Organizations (QIOs) are currently performing the 11th Scope of Work (SoW), which started 8/1/2014 and ends 7/17/2019.
The 11th SoW was designed to improve health and health care for all Medicare beneficiaries and promote quality of care to ensure the right care at the right time, every time. Contractual requirements align to the Affordable Care Act goals that are relevant to the QIO program and seek to increase access to high-quality, affordable health care for all Americans.
The QIO Program is based upon two core contract functions; quality improvement and case review. These functions include: reducing disparities in access and quality for priority populations, increasing use of health information technology, reducing adverse events related to health care- acquired infections, increasing care efficiency by promoting value within the health system, and improving the quality of life for patients nearing the end of life by alleviating pain with palliative care measures. To learn more, visit www.qioprogram.org.
As the QIN-QIO programs completed the 2nd year of the 11th SOW contracting period, some important results ending July 2016 are as follows:
- QIOs have reported and performed 276 successful Quality Improvement Initiatives (QII) that improves healthcare quality by assisting providers and/or practitioners to identify the root cause of a concern, develop a framework in which to address the concern, and improve a process or system.
- QIN-QIO have made progress to impact a total of 5,393,340 patients improving cardiac health and reducing disparities.
- Nationally, QIN-QIOs have recruited over 1800 practices and worked with 29 percent of Medicare beneficiaries (18,938/64,501) to complete diabetes self-management education within communities where it is convenient to beneficiaries.
- Nationally, there were approximately 8 million patients that were seen by QIN-QIO recruited EPs, EHs and CAHs using EHR functionality for quality improvement.
- QIN-QIOs have worked nationally with over 10,000 nursing homes to improve the quality of care for Medicare beneficiaries. Nearly 3,000 of these nursing homes are working directly to impact the CDI Project.
- The QIO Program has made great progress to helping providers, the QIN-QIOs recruited 294 communities that resulted in 9,124 avoidable readmissions and 250,765 potential adverse drug events avoided.
- QIN-QIOs have provided over 1,570 instances of technical assistance to hospitals, PPS-exempt Cancer Hospitals (PCHs), Inpatient Psychiatric Facilities (IPFs), Ambulatory Surgical Centers (ASCs) and physicians to improve quality care of beneficiaries; and coordinate community driven projects that advance efforts to achieve better care at lower costs.
- QIN-QIOs focus on improving immunization rates and increasing documentation, especially in minority and underserved populations which contributed to the progress of 328,378 of PPV and Influenza Vaccinations given by QIN-QIO recruited providers.
- QIN-QIOs have worked with nearly 1,400 of practices with clinicians in support to provide transformation and performance improvement through extensive collaboration, key change package concepts, and peer-based learning networks.
What are QIOs currently doing?
Led by the Centers for Medicare & Medicaid Services (CMS), the Quality Improvement Organization (QIO) Program is one of the largest federal programs dedicated to improving health quality at the local level.
The QIO Program aligns with the six CMS Quality Strategy goals:
- Make care safer by reducing harm caused in the delivery of care.
- Ensure that each person and family are engaged as partners in their care.
- Promote effective communication and coordination of care.
- Promote the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
- Work with communities to promote wide use of successful interventions to enable healthy living.
- Make quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.
This strategy supports the priorities of the Department of Health and Human Services’ (DHHS) National Quality Strategy.
In collaboration with health care and community partners, the QIO Program helps improve our nation’s quality of care. Over the past several years, QIOs nationwide have brought together thousands of hospitals, nursing homes, physician practices, and patient advocates to prevent pressure ulcers, avoid surgical complications, reduce health care-acquired infections and use technology to coordinate preventive care. QIO Program initiatives in communities across the country have resulted in dramatically fewer avoidable hospital readmissions and higher rates of preventive screenings. They’ve also equipped Medicare beneficiaries to play a more active role in managing chronic conditions.
Partnership for Patients
The Partnership for Patients initiative is a public-private partnership working to improve the quality, safety and affordability of health care for all Americans. Physicians, nurses, hospitals, employers, patients and their advocates, and the federal and State governments have joined together to form the Partnership for Patients. In 2016, the Centers for Medicare & Medicaid Services (CMS) awarded 16 national, regional, or state hospital associations and health system organizations to serve as Hospital Improvement Innovation Networks (HIINs). These awards will integrate the Partnership for Patients (PfP) Hospital Engagement Networks (HEN) into the Quality Improvement Network-Quality Improvement Organization (QIN-QIO) program in order to maximize the strengths of the QIO program and the PfP HENs to sustain and expand current national reductions in patient harm and 30 day readmissions for the Medicare program. The period of performance for the HIINs begins in September 2016 and consists of one 24-month base period and one 12-month option year, during which they will support 4,000 hospitals. The focus of the HIINs work going forward will be to sustain and accelerate national progress and momentum towards continued harm reduction in the Medicare program. Additionally, an essential element of this work is a commitment to improving health equity, and organizations will give specific attention to identifying and reducing health care disparities. The HIINs will continue to engage the hospital, provider and broader care-giver communities to quickly implement well-tested and measured best practices to improve the quality of care in the Medicare program.
Learn more about the Partnership for Patients at partnershipforpatients.cms.gov.
How do QIOs improve health delivery, status, and cost?
Nationally, the QIO Program aligns with major initiatives to improve patient safety and population health, such as Advancing Excellence in America’s Nursing Homes, Million Hearts and the Partnership for Patients. The QIO Program also works with leading organizations like AARP, the American Cancer Society, the Centers for Disease Control and Prevention, the Visiting Nurse Associations of America and many more. QIN-QIOs work with state and local chapters of these organizations, engaging them as community partners in learning and action networks and improvement collaboratives that rapidly effect large-scale change for the better. Collaboratively, they works toward four major goals: promoting effective prevention and treatment of chronic disease by promoting safe care that is patient and family-centered, reliable and accessible; making care safer and reducing harm caused in the delivery of care; promoting effective communication and coordination of care; and making care more affordable.
At the community level, QIN-QIOs work with Area Agencies on Aging to improve the experience of patients as they transfer from one care setting to another. They also work with state health departments to reduce the number of health care-acquired infections. QIN-QIOs unite hospital associations, medical groups, health plans, and numerous community-based partners to address the unique medical, social, and economic factors affecting care in the area.
Beneficiary and Family Centered Care (BFCC)-QIOs, which manage beneficiary complaints and quality of care reviews, also collaborate with QIN-QIOs, state health associations, beneficiary advocacy organizations and other stakeholders to spread the word about the services BFCC-QIOs provide to Medicare beneficiaries and their families and initiate quality improvement initiatives.
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 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) Independent Evaluation Contractor, for the 12th Statement of Work (12SoW). This contract collects data, conducts analysis, and develops reports to monitor progress toward 12SoW 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.
BFCC-QIO Changes that Affect Medicare Patients and Healthcare Providers- June 2019 (PDF)
Fact Sheet: QIN-QIOs - Providing Better Care at Lower Costs (PDF)
Fact Sheet: QIN-QIOs - Safe Care that is Person and Family-Centered, Reliable and Accessible (PDF)
Fact Sheet: Quality Innovation Network — Quality Improvement Organizations (QIN-QIOs) (PDF)
Fact Sheet: QIN-QIOs - Improving the Health Status of Communities (PDF)