CMS’ Quality Improvement Organization Program to Sharpen Focus on Chronic Disease Management

Sept. 3, 2019

Priorities also include behavioral health outcomes, patient safety

As the Centers for Medicare & Medicaid Services’ Quality Improvement Organization (QIO) Program wrapped up its 11th scope of work in July, its leaders in CMS’ Center for Clinical Standards and Quality reflected on the program’s past five years and its goals for the future.

In an interview published on the program website, Dennis Wagner, director of the Quality Improvement & Innovation Group, and Paul McGann, M.D., chief medical officer for quality improvement, discussed changes to the QIO program. McGann noted that in the 11th scope of work, they split up the two core functions of the QIO Program — quality improvement and case review, forming Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) and Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs. The BFCC-QIO work focused on better understanding what patients are facing when navigating the Medicare system. Three QIN-QIO initiatives include improving the health status for communities, making care safer for all patients and providing better care at lower costs.

Wagner added that in just the last year, QIN-QIOs helped more than 47,000 people with Medicare complete Diabetes Self-Management Education (DSME) courses, recruited more than 5,000 practices to increase the number of alcohol and depression screenings, and helped 75 percent of people with Medicare using tobacco to get cessation counseling. The BFCC-QIOs conducted more than 40,000 reviews for quality of care concerns, he added, and identified more than 23,000 opportunities for quality improvement across a variety of health service providers.

Health Services Advisory Group, the QIN-QIO for Arizona, California, Florida, Ohio and the U.S. Virgin Islands, was tasked with educating nearly 16,000 people with Medicare about diabetes self-management. “This was an enormous stretch goal for them, but they ended up exceeding it by 60 percent, educating, in total, 25,368 people with Medicare,” McGann added.

Asked what will be the top priorities for the QIO Program over the next five years, McCann mentioned five things:

• Behavioral health outcomes, including targeting the opioid crisis;

• Patient safety;

• Chronic disease management, incorporating diabetes efforts, the Million Hearts cardiovascular disease initiative, and the new Advancing Kidney Health work on chronic kidney disease (CKD) and end-stage renal disease (ESRD);

• Care transitions, and;

• Nursing home care, concentrating on the problem of abuse of nursing home residents.

“We’ll specifically be targeting cardiovascular disease — continuing the incredible work being done with the Million Hearts initiative — as well as diabetes prevention and kidney disease/ESRD,” McCann added. “With regard to CKD, we want to help people with Medicare identify the disease early or even prevent it when possible. For those with ESRD, we want to work to get them a kidney transplant quickly."

Wagner also said the program would focus on cross-cutting priorities to address the needs of small, rural and vulnerable populations, and put an even greater emphasis on patient and family engagement. “It’s essential that we take those five main priorities and make sure they’re all implemented within our communities,” he said.