Medicare QIOs Want to Maximize Their Digital Potential
Civitas Networks for Health recently surveyed 11 Medicare Quality Improvement Organizations (QIOs) about their collective achievements and their recommendations for improving the program.
The nonprofit Civitas’ QIO survey report showcases work done in the most recent five-year contract cycle (2019-2024) for core Quality Improvement Network (QIN-QIO) activities and a four-year cycle (2020-2024) for Hospital Quality Improvement Contractor (HQIC) activities.
The 11 surveyed prime or subcontractors were Alliant Health, Comagine Health, Compass Healthcare Collaborative, MetaStar, Convergence, iMPROve Health, Kansas Healthcare Collaborative, KFMC Health Improvement Partners, Quality Insights, Stratis Health, and Telligen.
Using CMS’ own guidance, the QIN-QIO community health activities of Civitas members over just the final two years (2022-24) of the most recent 5-year contract cycle generated $4.7 billion in Medicare savings across a multi-regional block of 11 states, primarily by reducing preventable ED visits, hospitalizations and 30-day hospital readmission rates.
The operationally separate QIN-QIO activities at nursing homes in four different regions covering 20 states likewise saved $165 million over the same two-year period, for the same reasons—a $57 return for every dollar spent on the QIOs’ work.
The survey report says the QIOs make the case for continued funding of the programs. “Beyond the substantial return on investment generated by the QIN-QIO and HQIC programs and their measurable impact on providers and beneficiaries, the end of the core QIO program would leave a large gap in the resources available to hospitals, nursing homes, and other facilities serving some of the country’s highest need populations (very much including rural areas),” the report says.
As the report about the survey notes, “QIO technical assistance is the product of specialized organizations that combine years of experience working inside the Medicare ecosystem as trusted resources with proven approaches combining public and private sector best practices to advance care quality nationwide. Even if for-profit vendors could deliver identical services and supports without federal funding, most small care homes and critical access hospitals would not be able to pay for them, leaving the government to pay for more sick care and inefficiencies. State and local governments would likewise be hard-pressed to completely fill the void in a way that can truly replicate the capabilities of the existing federal program absent larger transfers of public health funds.”
Given the record of success, Civitas QIOs support the continued funding through this next phase of contracts, and encourage future investment in program sustainability for continuity and oversight of previous investments.
Among recommendations for changes to the program, survey respondents stressed that more can be done to maximize their digital potential. “QIN-QIOs should have more latitude to adjust measure specifications based on real-world feedback and field experience, and CMS should reduce the remaining barriers to data sharing between QIOs and public/nonprofit HIEs, APCDs and QHINs (where applicable).”
Another suggestion is that the HQIC program should lean further into HIE/EHR interoperability for better access to tools like data dashboards.
QIOs said they would welcome more CMS support for prioritizing “boots on the ground” — the onsite, in-person training —where most valuable to drive improvement while leveraging virtual options, as appropriate.
The QIOs told Civitas that CMS should place greater emphasis on “sustainability infrastructure” aimed at consolidating and advancing program work beyond each contract cycle. “The most important factor here is the low staff and leadership retention rates at participating facilities—a systemic problem that the QIO program cannot single-handedly address but can help mitigate in the context of its objectives to implement best practice reforms. Both QIN-QIO and HQIC portfolios should allocate more resources to leadership training and consider incorporating the hiring process into their workforce retention strategies.”
Finally, the QIOs said CMS should more formally recognize “zero-baseline” hospitals (those with zero harm rates for tracked conditions over multiple years) within the structure of the HQIC program to showcase the achievement and promote effective resource allocation by emphasizing the highest-need, highest-risk hospitals that are furthest from zero-baseline. Examples of tracked conditions that a few facilities engaged by HQICs have already “taken to zero” include opioid ADEs, central line-associated bloodstream infections (CLABSI), and catheter-assisted urinary tract infections (CAUTI).
