Re-energized QIO Program to Benefit Patients, Agencies

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)
Re-energized QIO Program to Benefit Patients, Agencies

Patients and caregivers should benefit from new contracts awarded by the Centers for Medicare and Medicaid Services (CMS) as it transforms the Quality Improvement Organization (QIO) program for Medicare beneficiaries. Participating home health agencies also could gain by improving patient outcomes.

This marks the second phase of the reorganization, which began in May when CMS awarded contracts to two Beneficiary and Family-Centered Care (BFCC) QIO contractors to conduct case review and monitoring activities. Fourteen organizations have been awarded five-year Quality Innovation Network (QIN-QIO) contracts to work with providers and communities on data-driven quality initiatives in the award area.

QIN-QIOs are mainly comprised of private, nonprofit organizations made up of healthcare professionals who review medical care, address beneficiary care complaints, and look to improve care quality in their jurisdictions. All areas except Indiana, Puerto Rico, and the U.S. Virgin Islands have been awarded QIN-QIOs. Those awards are expected later.

The organizations will focus on such strategic initiatives as:

  • Reducing healthcare associated infections
  • Reducing readmissions and medication errors
  • Working with nursing homes to improve care for residents
  • Supporting clinical practices in using interoperable health information technology to enable the exchange of essential  health information to improve the coordination of care
  • Promoting prevention activities
  • Reducing cardiac disease and diabetes
  • Reducing healthcare disparities
  • Improving patient and family engagement

QIN-QIOs are expected to take an active role in enrolling agencies in the Home Health Cardiovascular Data Registry, part of the Home Health Quality Improvement (HHQI) National Campaign. More than 600 home health agencies have signed up for the registry, which allows free access to customized, proprietary cardiovascular health reports that provide insight into specific opportunities to improve preventive cardiovascular care among an agency’s patient population.

The QIO program has been credited with saving nearly $1 billion over the previous five-year period by preventing more than 95,000 hospitalizations and 27,000 readmissions among Medicare recipients.

Are you looking for more CMS programs to help your agency succeed? The Medicare Care Choices Model is designed to test quality of care and patient/family satisfaction.

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