Medicare Quality Improvement:
An Overview of the Next Five Years
Mary Fermazin, MD, MPA, Chief Medical Officer
Chad Vargas, MHA Candidate, Associate Director,
Care Transitions and Special Projects
Presentation Outline
• About Health Services Advisory Group, Inc. (HSAG)
• The role of the Quality Innovation Network-Quality
Improvement Organization (QIN-QIO)
• QIO program changes
• QIN-QIO areas of focus
2
About HSAG
About HSAG
• Committed to improving quality of healthcare for
more than 35 years
• Provides quality expertise to those who deliver care
and those who receive care
• Engages healthcare providers, stakeholders,
Medicare patients, families, and caregivers
• Provides technical assistance, convenes learning and
action networks, and analyzes data for improvement
4
About HSAG (cont.)
Nearly 25 percent of the
nation’s Medicare beneficiaries
HSAG is the Medicare QIN-QIO for California, Ohio, Arizona,
Florida, and the U.S. Virgin Islands.
5
What is a QIN-QIO?
• Funded by the Centers for
Medicare & Medicaid Services
(CMS)
– Dedicated to improving health
quality at the community level
– Ensures people with Medicare
get the care they deserve, and
improves care for everyone
6
CMS Quality
Strategy
QIN-QIO
Activities
7
Goals are Aligned
Affordable Care
Act/National
Quality Strategy
1. Make care safer
2. Strengthen person and
family engagement
3. Promote effective
communication and
coordination of care
4. Promote prevention and
treatment of chronic
disease
5. Work with communities to
promote best practices of
healthy living
6. Make care affordable
QIO Program Changes
Duration and Scope of Contract
Three-Year,
State-Based Contracts
Quality Improvement
Organization (QIO)
9
Five-Year,
Regional Contracts
Quality Innovation NetworkQuality Improvement
Organization (QIN-QIO)
}
Medical Case Review and QIO Separated
Medical Case
Review
(for beneficiaries and
their families)
10
QIN-QIO
QIN-QIO Areas of Focus
Cardiac Health
HealthcareAcquired
Conditions in
Nursing Homes
Value-Based
Payment
Program
Disparities in
Diabetes
Patient is at the center of care.
Coordination of
Care
12
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/dual-eligibles, and providers to
improve ABCS
13
Cardiac Health: Evidence-Based Practices
Aspirin therapy as primary
prevention
Five A’s model for smoking
cessation
Partner with proven
campaigns
Use of early statin regimens
14
Cardiac Health: Support Million Hearts®
Enhance Health Information
Technology (HIT)
Foster clinical innovations
Educate and empower
individuals
Community initiatives to
support healthier behaviors
15
Cardiac Health: Promote the ABCS
Step
3
Step
2
Use electronic health records
to identify gaps in care
Step 1
Identify workflow
optimization opportunities
Identify areas/neighborhoods
with the highest need
Work with providers
16
Map image from New York Times: Where are the Hardest Places to Live in the U.S.?
http://www.nytimes.com/2014/06/26/upshot/where-are-the-hardest-places-to-live-in-the-us.html?abt=0002&abg=1&_r=1
Cardiac Health
HealthcareAcquired
Conditions in
Nursing Homes
Value-Based
Payment
Program
Disparities in
Diabetes
Patient is at the center of care.
Coordination of
Care
17
HealthcareAssociated
Infections in
Hospitals
Chronic Disease
Management
Through
Meaningful Use
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
18
Reduce Disparities in Diabetes Care:
Self-Management Education Training Classes
• Train-the-trainer program to increase the number of
diabetes educators, certified diabetes educators, and
community health workers
• Referrals of patients with diabetes from recruited
medical providers
• Community-based approach to encourage program
spread
19
Reduce Disparities in Diabetes Care: Increase
Adherence for Utilization Measures
• Includes HbA1c, lipids,
eye exams
– Provider engagement
strategies
– Clinical data input and
reporting through EHR
– Reporting on eye exams
and foot exams
20
Cardiac Health
HealthcareAcquired
Conditions in
Nursing Homes
Value-Based
Payment
Program
Disparities in
Diabetes
Patient is at the center of care.
Coordination of
Care
21
HealthcareAssociated
Infections in
Hospitals
Chronic Disease
Management
Through
Meaningful Use
Coordination of Care
• Reduce hospital admission and readmission rates by
20 percent by 2019
• Increase community tenure (increase number of
nights spent at home by 10 percent)
• Reduce prevalence of adverse drug events that
contribute to patient harm as a result of the care
transitions process
• Convene community providers to collaborate on
strategies for improvement in care coordination
22
Cardiac Health
HealthcareAcquired
Conditions in
Nursing Homes
Value-Based
Payment
Program
Disparities in
Diabetes
Patient is at the center of care.
Coordination of
Care
23
HealthcareAssociated
Infections in
Hospitals
Chronic Disease
Management
Through
Meaningful Use
Improve Prevention Coordination through
Meaningful Use of HIT
• Coordinate with Regional Extension Centers to
disseminate successful interventions
• Foster HIT adoption to improve beneficiary care
• Increase screening and delivery of preventive
services with the use of electronic health record
technology
• Improve access to care and coordination by
supporting beneficiary and family engagement
24
Cardiac Health
HealthcareAcquired
Conditions in
Nursing Homes
Value-Based
Payment
Program
Disparities in
Diabetes
Patient is at the center of care.
Coordination of
Care
25
HealthcareAssociated
Infections in
Hospitals
Chronic Disease
Management
Through
Meaningful Use
Reduce Healthcare-Associated Infections
(HAIs) in Hospitals
• Prevent occurrence of HAIs using data-driven,
evidence-based practices
• Use results to initiate quality improvement initiatives
in intensive care and non-intensive care units
• Develop and provide recommendations for
improvement strategies
• Use HAI data and outcomes to inform results and
policy at the national level
26
Cardiac Health
HealthcareAcquired
Conditions in
Nursing Homes
Value-Based
Payment
Program
Disparities in
Diabetes
Patient is at the center of care.
Coordination of
Care
27
HealthcareAssociated
Infections in
Hospitals
Chronic Disease
Management
Through
Meaningful Use
Quality Improvement through Physician ValueBased Payment
• 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
28
Cardiac Health
HealthcareAcquired
Conditions in
Nursing Homes
Value-Based
Payment
Program
Disparities in
Diabetes
Patient is at the center of care.
Coordination of
Care
29
HealthcareAssociated
Infections in
Hospitals
Chronic Disease
Management
Through
Meaningful Use
Reduce Healthcare-Acquired Conditions in
Nursing Homes
• Support National Nursing Home Quality Care
Collaborative initiatives
• Achieve score of 6.0 or lower on the Nursing Home
Quality Composite Measure
• Improve rates of mobility among long-stay nursing
home residents
• Reduce use of unnecessary antipsychotic
medications in dementia residents
30
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Thank you!
Mary Fermazin|818.265.4657|mfermazin@hsag.com
Chad Vargas|818.265.4688|cvargas@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.1-09052014-01