An Introduction to the TMF Quality Innovation Network

Quality Improvement Organization

Vanessa Andow, CPHQProgram Manager, Readmissions

Oklahoma Home Health AssociationSeptember 16, 2014

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About the QIN-QIO ProgramLeading 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.

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 (QIN- QIOs)

› 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.

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11thSOW 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 (QIN- QIOs)

› 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 Address Toll-Free Number Fax Number

Livanta

1 Livanta BFCC-QIO Program 9090Junction Drive, Suite 10Annapolis Junction, MD 20701

866-815-5440Appeals: 855-236-2423

All other reviews844-420-6671

5 Livanta BFCC-QIO Program 9090Junction Drive, Suite 10Annapolis Junction, MD 20701

877-588-1123

Appeals: 855-694-2929All other reviews

844-420-6672

KEPRO

2 5201 W. Kennedy Blvd., Suite 900Tampa, FL 33609 844-455-8708 844-834-7129

3 5700 Lombardo Center Dr., Suite 100 Seven Hills, OH 44131

844-430-9504 844-878-7921

4 5201 W. Kennedy Blvd., Suite 900Tampa, FL 33609 855-408-8557 844-834-7130

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)

TMF QIN-QIO’s Strategies for Change Community Organizing and Coalition Building

› 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 fourth-

leading 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 NetworkHome 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).

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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

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 Self-Management 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) 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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30Source: 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.

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

Care Coordination: Reducing Readmissions Recruit communities where 60 percent of Medicare Fee-for-

Service (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. health care costs.1

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 drug reactions, allergic reactions and overdoses.2,3

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.

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 region-wide 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 ImprovementValue-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 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

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

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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