An Introduction to the
TMF Quality Innovation Network
Quality Improvement Organization
Vanessa Andow, CPHQ
Program Manager, Readmissions
Oklahoma Home Health Association
September 16, 2014
About the QIN-QIO Program
Leading rapid, large-scale change in health
quality:
 Goals are bolder.
 The patient is at the center.
 All improvers are welcome.
 Everyone teaches and learns.
 Greater value is fostered.
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Major Changes to the CMS Quality
Improvement Organization Program
 The Centers for Medicare & Medicaid Services (CMS) separated medical
case review from quality improvement work creating two separate
structures:
› Medical case review to be performed by Beneficiary Family Centered
Care Quality Improvement Organizations (BFCC-QIOs)
› Quality improvement and technical assistance QIOs to be performed by
Quality Innovation Network Quality Improvement Organizations (QINQIOs)
› Note: Both types of contracts cannot be held by the same organization
 BFCC-QIOs are organized among five geographic areas across the Nation.
 QIN-QIOs are regional and cover up to six states and/or territories.
 The QIO contract cycle will be extended from 3 to 5 years.
th
11 SOW
QIN-QIO Map
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11th Scope of Work (SOW) –
Major Changes
 The Centers for Medicare & Medicaid Services (CMS) separated medical
case review from quality improvement work creating two separate
structures:
› Medical case review to be performed by Beneficiary Family Centered
Care Quality Improvement Organizations (BFCC-QIOs)
› Quality improvement and technical assistance to be performed by
Quality Innovation Network Quality Improvement Organizations (QINQIOs)
› Note: Both types of contracts cannot be held by the same organization
 BFCC-QIOs are organized among five geographic areas across the nation.
 QIN-QIOs will be regional and could cover anywhere from three to six
states.
 The QIO contract cycle will be extended from three to five years.
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BFCC-QIO SOW – What’s New?
 Enhancements to the BFCC-QIO SOW
› Five CMS defined areas
• Each required to maintain local presence
› Business hours seven days a week
• Staffing to cover the following times in each time zone within
the QIO area
– Mon-Fri 9 a.m.-5 p.m.
– Weekends/holidays 11 a.m.-3 p.m.
 On May 9, CMS awarded the Beneficiary and Family Centered Care
(BFCC) Quality Improvement Organization (QIO) Program
contracts to:
› Ohio-based KEPRO for 33 states and the District of Columbia; and
› Maryland-based LIVANTA for 17 states, the USVI and Puerto Rico
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BFCC QIO Important Contacts
Area
Livanta
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KEPRO
2
3
4
Address
Livanta BFCC-QIO Program 9090
Junction Drive, Suite 10
Annapolis Junction, MD 20701
Livanta BFCC-QIO Program 9090
Junction Drive, Suite 10
Annapolis Junction, MD 20701
5201 W. Kennedy Blvd., Suite 900
Tampa, FL 33609
5700 Lombardo Center Dr.,
Suite 100
Seven Hills, OH 44131
5201 W. Kennedy Blvd., Suite 900
Tampa, FL 33609
Toll-Free Number
Fax Number
Appeals: 855-236-2423
866-815-5440
All other reviews
844-420-6671
Appeals: 855-694-2929
877-588-1123
All other reviews
844-420-6672
844-455-8708
844-834-7129
844-430-9504
844-878-7921
855-408-8557
844-834-7130
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CMS Quality Strategy: Aligns with NQS
and IOM Strategies
 Make care safer by reducing harm caused in its
delivery
 Strengthen person and family engagement
 Promote effective communication and care
coordination
 Promote effective prevention and treatment of
chronic disease
 Work with communities to promote best practices
 Make care affordable
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TMF QIN-QIO Regional Partners
 TMF has subcontracted with strong, experienced quality
improvement partners to provide expert technical assistance
and quality improvement support for participating providers
across the region.
› Arkansas Foundation for Medical Care
› Primaris (Missouri)
› QIPRO (Puerto Rico)
› TMF Health Quality Institute (Texas and Oklahoma)
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TMF QIN-QIO’s Strategies for Change
 Community Organizing and Coalition Building
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Develop shared community leadership
Develop a purpose for the community team
Work with a cross-continuum of providers
Identify the right participants and continuously recruit new members
 Learning and Action Networks
› A virtual gathering place to communicate with providers, stakeholders
and beneficiaries
› Provide educational events, resources, tools and data portal
 Provider/ Practitioner Technical Assistance
› Hands-on assistance with community organizing, root cause analysis,
intervention implementation and monitoring
› Provider-specific education and consultation
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CMS Goal 1: Promote Effective Prevention
and Treatment of Chronic Disease
 Improving Cardiac Health & Reducing Cardiac
Disparities
 Reducing Disparities in Diabetes Care: Everyone
with Diabetes Counts
 Improving Prevention Coordination Through
Meaningful Use of Health Information Technology
(HIT)
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Improving Cardiac Health & Reducing
Cardiac Healthcare Disparities: The Data
 Heart disease and stroke are the first- and fourthleading causes of death, respectively, according to
the Centers for Disease Control and Prevention (CDC)
 Congestive heart failure is the second most frequent
diagnosis related group (DRG) related to 30-day
hospital readmissions
 Morbidity and mortality data suggests the risks are
far greater for racial and ethnic populations than
whites
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The Cardiac Project
 Work with providers and beneficiaries in collaboration with
key partners and stakeholders
 Work together in a Cardiac Learning and Action Network
 Target racial and ethnic minority Medicare beneficiaries, dual
eligible and providers practitioners who serve them
 Support Million Hearts® Campaign: prevent one million heart
attacks and strokes by 2017
 Focus on evidenced-base: ABCS (ASA, BP, Cholesterol, Smoking
Cessation)
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The Cardiac Project: Targeted Providers
› Home health agencies
• Participate in Cardiovascular Data Registry, Home Health Quality
Improvement (HHQI) Campaign
› Practitioner owned and operated offices and clinics
› Other facilities where physician, nurse practitioner,
physicians assistant oversight is provided
› Providers, practitioners required to be Physician Quality
Reporting System (PQRS) aligned
› Providers, practitioners who serve racial and ethnic
minorities
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Cardiovascular Health Network
Home Health Agencies (HHAs)
We help HHAs sign up for the Cardiovascular Data Registry, developed through
the Home Health Quality Improvement National Campaign, in order to track
progress related to the ABCS (Aspirin therapy, Blood pressure management,
Cholesterol control and Smoking/Tobacco cessation).
Utilize the Best
Practice Intervention
Packages (BPIPs) to
provide Technical
Assistance
Utilization of
health literacy
tools to provide
education
Participate in cardiac
Learning and Action
Network activities and
share success stories
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Improving Cardiac Health: Goals
 Prevent one million heart attacks and strokes – Support Million
Hearts® Campaign
 Spread the implementation of evidence-based practices: ABCS
 Practice goals by January 2019:
› 70 percent patients blood pressure (BP) controlled, per
guidelines
› 70 percent patients screened for tobacco use
› 70 percent identified as smokers receive smoking cessation
counseling
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Reducing Disparities in Diabetes Care:
Everyone with Diabetes Counts: The Data
 Our first project focused on the Hispanic and Native American
populations and revealed that from the time of diagnosis to
the time our participants were receiving Diabetes SelfManagement Education (DSME) was...
7 – 13 years
 Our current project with African-Americans reveals that only
2.9 percent of those with Medicare and diabetes are utilizing
their DSME benefits.
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Everyone with Diabetes Counts:
The Goals
 Increase number beneficiaries who complete
DSME classes
› Obtain repeated measurements on the same
beneficiaries longitudinally over time
› HbA1c, lipids, eye exam, BP control, weight
 Decrease lower extremity amputations
 Improve health literacy diabetics
 Increase adherence to clinical guidelines
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Improving Prevention Coordination with
Meaningful Use of HIT (slide 1 of 3)
 Closes the gap between patient care (diagnostics, etc.) and
outcomes
 Complete, organized patient’s chart in hand at all times
 Facilitates implementation of evidence-based best practices
 Allows management of patient panels
 Promotes transparency
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Improving Prevention Coordination with
Meaningful Use of HIT (slide 2 of 3)
 Influences improved outcomes with data at the practice’s
fingertips
 Alerts and reminders for safer patient care
 eRxing provides more efficient and accurate drug dispensing
 Support IT-enabled care management for primary care
prevention and early diagnosis
 Improve specific health care services, processes and health
outcomes related to prevention, population health and care
coordination
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Improving Prevention Coordination with
Meaningful Use of HIT (slide 3 of 3)
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Effective use of clinical decision support and quality measurement
Eligible professionals, hospitals and critical access hospitals
Recruit providers and hospitals with electronic health records (EHRs)
Reduce HIT disparities
Target most challenged to meet EHR incentives and quality
improvement goals
Provide technical assistance and coaching 1-on-1 and virtually
Monthly reporting and data analysis
Improve care team and patient communication
Engage beneficiaries
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CMS Goal 2: Make Care Safer by Reducing
Harm Caused in the Delivery of Care
 Reducing Healthcare-Associated Infections (HAIs) in
Hospitals
 Reducing Healthcare-Associated Conditions in
Nursing Homes
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Reducing HAI Infections in
Hospitals: The Data
 An analysis describes the average total cost of a typical
Clostridium difficile (C. diff) case at $12,834.91, or
$4,486.09 more (54 percent higher) than the adjusted
hospital cost for an inpatient who does not have C. diff.
 Patients who were admitted for recurrent C. diff had an
average length of stay of approximately 8.8 days, and
their average direct cost per recurrence was $4,096.93.
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Reducing Healthcare-Associated Infections
in Hospitals: The Project
 Recruit hospitals with Central-Line Associated Blood Stream
Infection (CLABSI) rates above national averages
 Work in CLABSI, CAUTI and C. diff reduction in both
Intensive Care Unit (ICU) and non-ICU settings
 Ventilator Associated Events reduction education
 Use root cause analysis to determine causes of infections
and target interventions
 Educational webinars tailored to identified causes
 Education on reporting National Healthcare Safety Network
(NHSN) data
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Reducing Healthcare-Acquired Conditions
in Nursing Homes: The Data
 An estimated 1.4 million Americans live in nursing homes on any
given day and approximately one in five, or 22 percent, suffer
harm during their stay.
 Nearly 60 percent of these incidents are deemed preventable,
leading to a national call for improved safety and quality of care
for nursing home residents.
 MORE THAN ½ of residents who experienced harm returned to the
hospital for treatment. $2.8 BILLION in hospital costs attributed to
harm caused in nursing homes in one year.
 Oklahoma is 39th (worst in nation) in using antipsychotics
inappropriately in nursing homes
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Reducing Healthcare-Acquired
Conditions in Nursing Homes
 Recruit 75 percent of all nursing homes including 75
percent of one star facilities – 58 nursing facilities in
Oklahoma
 National Collaborative, two rounds of recruitment
 Individualized technical assistance to all recruited nursing
homes
 Coaching on initiating a Quality Assurance and Performance
Improvement (QAPI) culture
 Local Area Network for Excellence (LANE) convener
 Engage beneficiaries
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Nursing Home Project Goals
 Reduction in percentage of residents who receive
antipsychotic medications
 Percentage of long-stay residents with improved
mobility
 Percentage of facilities recruited, including low
performers
 Attain composite score of six or better on the Nursing
Home Quality Composite Measure (13 National Quality
Forum-endorsed long-stay quality measures)
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CMS Goal 3: Promote Effective
Communication and Coordination
of Care
Care Coordination: Reducing Readmissions
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Statement of Problem:
Readmissions
 Hospitalizations consume 31 percent
of the $2 trillion in total health care
expenditures in the United States
› One in four (25 percent) of
hospitalizations are avoidable
› One in five (20 percent) of all
hospitalizations result in 30-day
readmissions
Source: Lynn J, Straube BM, Bell KM, Jencks SF, Kambic RT. Using population segmentation to
provide better health care for all: The “Bridges to Health” model. Milbank Q. 2007;85:185-208.
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Care Coordination: Reducing
Readmissions
 Recruit communities where 60 percent of Medicare Fee-forService (FFS) beneficiaries reside
 Provide one-on-one and virtual technical assistance to
hospitals, downstream providers and communities
 Educate on best practices, root cause analysis, implementing
interventions, monitoring progress and understanding the
data
 Recruit and form community coalitions
 Coordinate and conduct community workgroup meetings
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Statement of Problem:
Medication Safety
 National estimates suggest that adverse drug events
(ADEs) contribute an additional $3.5 billion dollars to U.S.
1
health care costs.
 Given the U.S. population’s large and ever-increasing
magnitude of medication exposure, the potential for harm
from ADEs is a critical patient safety and public health
challenge.
 ADEs are a direct result of drugs used during medical care
that produce harmful events. These harmful events can
include, but are not limited to, medication errors, adverse
2,3
drug reactions, allergic reactions and overdoses.
1Institute
of Medicine Committee on Identifying and Preventing Medication Errors. Preventing Medication Errors:
Quality Chasm Series. Washington, DC: The National Academies Press, 2006.
2Agency for Healthcare Research and Quality. Adverse Drug Event (ADE), in Patient Safety Network: Glossary. Available
at: http://psnet.ahrq.gov/glossary.aspx.
3National Action Plan for Adverse Drug Event Prevention. U.S. Department of Health and Human Services, Office of
Disease Prevention and Health Promotion, 2013.
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Care Coordination: Reducing
Adverse Drug Events (ADEs)
 Recruit 10 percent of FFS beneficiaries in region, with 10 percent in
“rural” areas.
 Use organization and physician level reports to perform root cause
analyses on ADEs for anticoagulants, oral hypoglycemic
medications and opioids
 Use data to map out barriers and solutions
 Focus on medication reconciliation and medication therapy
management
 Share evidence-based practices and tools with practitioners and
patients
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Care Coordination: Reducing
Adverse Drug Events (ADEs)
 Provide one-on-one and virtual technical assistance to
recruited organizations and stakeholders
 10 percent relative improvement rate (RIR) in percentage of
30-day readmissions per 1,000 FFS beneficiaries in a regionwide coalition
 7 percent RIR in percentage of admissions per 1,000
beneficiaries in region wide coalition
 Reduce ADEs in these populations by 50 percent RIR per 1,000
patients by the end of the contract
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CMS Goal 4: Make Care More
Affordable
Quality Improvement through Value-Based
Payment, Quality Reporting and Physician
Feedback Reporting
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Quality Improvement
Value-Based Payment Modifier
 Target hospitals, inpatient psychiatric facilities, ambulatory
surgical care centers, outpatient departments, physicians,
physician groups, critical access hospitals, cancer hospitals
 Analyze quality and resource use reports
 Assist in improving measures
 Network with similar facilities for support and best practice
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TMF QIN-QIO
Learning and Action Networks (LANs)
 Provide targeted technical assistance to participating providers,
stakeholders and communities in CMS quality improvement
initiatives
 Engage providers and stakeholders in improvement initiatives
through web-based Learning and Action Networks
 The networks serve as hubs for the regional quality improvement
work for each project, including:
› Project information
› Data portal
› Upcoming events
› Project maps and data
› Discussion forums
› Videos
› Resource library
› Recorded events
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Learning and Action Networks
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Cardiovascular Health and Million Hearts
Health for Life – Everyone with Diabetes Counts
Healthcare-Associated Infections
Meaningful Use (Health Information Technology)
Medication Safety
Nursing Home Quality Improvement
Quality Reporting and Incentive Programs
Quality Improvement Initiative
Readmissions
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TMF QIN-QIO Learning and Action
Network: http://www.TMFQIN.org
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For more information
Vanessa Andow, CPHQ
Program Manager, Readmissions
TMF Quality Innovation Network
Phone: 512-334-1642
Email: Vanessa.Andow@hcqis.org
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Questions?
It is not the answer that enlightens,
but the question…
- Eugene Ionesco
This material was prepared by TMF Health Quality Institute, the Medicare Quality Innovation Network Quality
Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an
agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS
policy. 11SOW-QINQIO-C3-14-07
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