Medicare Quality Improvement and
Provider Technical Assistance:
An Overview of the Next Five Years
December 8, 2014
Mary Fermazin, MD, MPA, Chief Medical Officer
Health Services Advisory Group
Presentation Outline
• A review of QIN-QIO’s scope of work in general,
with special emphasis on the work with physician
practices
• Technical Assistance to Providers
– Million Hearts campaign
– Chronic care management of diabetes care
• Patient Community Meetings
– Diabetes Self Management Education
– Check.Change.Control
2
QIN-QIO Framework
3
QIN- QIO : Results Oriented Quality
Improvement
• Serve as neutral convener and actively engage
providers, partners and patients
• Utilize data as core component of QI efforts,
provide regular data feedback reports
• Use Learning and Action Networks to facilitate rapid
learning, disseminate best practices that lead to
system changes and sustainable results
• Provide focused technical assistance and coaching
4
Chronic Care Model
5
Cardiac Health
HealthcareAcquired
Conditions in
Nursing Homes
Value-Based
Payment
Program
Disparities in
Diabetes
Patient is at the center of care.
Coordination of
Care
6
HealthcareAssociated
Infections in
Hospitals
Chronic Disease
Management
Through
Meaningful Use
Improve Cardiac Health and
Reduce Disparities
• Implement evidence-based practices to improve
cardiovascular health
• Support Million Hearts® initiative
• Promote the use of Aspirin, Blood pressure control,
Cholesterol management, and Smoking assessment
and cessation (ABCS)
– Work with racial and ethnic minority beneficiaries/dualeligibles, and providers to improve ABCS
7
Technical Assistance
• Million Hearts
– Physician Quality Reporting System using EHR
– EHR reports on patients with hypertension
– Workflow analysis and redesign for managing patient
panels
– Controlling High BP; Tobacco Use: Screening and
Cessation; IVD: Use of Aspirin or Another Antithrombotic;
and Fasting LDL-C Test Performed and Stratified
8
Technical Assistance
• TA focus: those providers who manage patients with
the greatest cardiovascular health needs and those
most challenged to succeed in implementing
evidence-based practices to improve cardiovascular
health and support the Million Hearts® initiative.
• Eligible Providers
– Current measures below Million Hearts goal of 65%
– Target providers who serve racial and ethnic minority
Medicare beneficiaries, dual-eligible Medicaid and
Medicare beneficiaries
9
Reduce Disparities in Diabetes Care:
Everyone with Diabetes Counts
• Improve HbA1c, lipids, blood
pressure, and weight control
– Combination of provider-based
and community-based strategies
• Decrease number of
beneficiaries requiring lowerextremity amputations
– Claims data evaluation and
aggregation of data for the state
and the QIN-QIO area
10
Reduce Disparities in Diabetes Care:
Self Management Education Training Classes
• Use train-the-trainer program to increase the
number of certified diabetes educators and
community health workers
• Refer diabetic patients from recruited medical
providers
• Use community-based approach to encourage
program spread
11
Reduce Disparities in Diabetes Care: Increase
Adherence of Utilization Measures
• Includes HbA1c, lipids, eye
and foot exams
– Provider engagement
strategies
– Clinical data input and
reporting through EHR
– Reporting on eye exams and
foot exams
12
Technical Assistance
• Chronic care management of diabetes care
– EHR reports on patients with hypertension
– Workflow analysis and redesign for managing patient
panels
– Increasing adherence to clinical guidelines for
appropriate use of utilization measures for HbA1c, Lipids,
and Eye Exams
– Decrease lower extremity amputations
– Refer patients with diabetes to DSME
13
Technical Assistance
TA Focus:
• At least 25% of a Participating Practitioner
Clinics/Offices/Practices Medicare diabetes patient
population are a racial or ethnic minority/rural/ or in
an underserved area
• Based on analysis of Medicare claims, each
Participating Practitioner Clinic/Office/Practice with
claims results ranked in the lower 50th percentile
among all practices in the QIN-QIO area for at least
two of the three utilization measures: HbA1c, Lipids,
and Eye Exam. (FQHCs and RHCs are exempt)
14
Quality Improvement through Value-Based
Payment Programs
• Increase number of eligible physicians and physician groups
submitting data through Physician Quality Reporting System
(PQRS)
• Demonstrate improvement in quality of care delivered by
physician groups and hospital outpatient departments
• Increase national performance levels on hospital VBP
measures
• Increase percentage of ambulatory surgery centers and
inpatient psychiatric facilities that improve quality on poorly
performing quality measures
15
Patient Community Meetings
• Engage patients and families in the community through
meetings where they congregate:
– Senior centers
– Faith-based organizations
– Libraries
• Engage partners in patient community meetings, such
as providers, the American Heart Association, clinical
pharmacists, etc. to educate patients on:
–
–
–
–
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Self management of chronic disease
Patient portals
Medication safety
Availability of community health resources
Questions?
Mary Fermazin|818.265.4657|mfermazin@hsag.com
Chad Vargas|818.265.4688|cvargas@hsag.com
Kim Salamone |602.801.6960|ksalamone@hsag.com
This material was prepared by Health Services Advisory Group, Inc., the Medicare
Quality Improvement Organization for California, under contract with the Centers for
Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and
Human Services. The contents presented do not necessarily reflect CMS policy.
Publication No.CA-11SOW-B.1-09242014-02