Presentation on theme: "Vanessa Andow, CPHQ Program Manager, Readmissions"— Presentation transcript:
1 An Introduction to the TMF Quality Innovation Network Quality Improvement Organization Vanessa Andow, CPHQProgram Manager, ReadmissionsOklahoma Home Health AssociationSeptember 16, 2014
2 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.The Quality Innovation Network-Quality Improvement Organization (QIN-QIO) Program is the largest federal program dedicated to improving health quality at the community level. QIN-QIOs in defined regions across the country, united in a network administered by CMS, have the flexibility to respond to local needs.Leading rapid, large-scale change in health qualityIn August 2011, the Centers for Medicare & Medicaid Services gave the program an updated charter for leading change. Here are some of the biggest differences between today’s program and that of the past:• Goals are bolder. The QIN-QIO Program supports the aims of the Department of Health and Human Services’ National Quality Strategy. Providers that work with their QIN-QIO, for example, will contribute to improved cardiac health, fewer avoidable hospital readmissions, and a 40% national reduction in health care-acquired conditions.• The patient is at the center. By including the voice of the beneficiary in all their activities, QIN-QIOs are leading the way to patient-centered care. They will equip both providers and patients for shared health care decision making through a national Patient and Family Engagement Campaign.• All improvers are welcome. Embracing “boundarilessness” as a prerequisite for system-wide change, QIN-QIOs are breaking down organizational, cultural and geographic barriers. Initiatives are open to providers at all levels of clinical performance that make a commitment to improvement.• Everyone teaches and learns. Through large-scale learning and action networks, QIN-QIOs are accelerating the pace of change and rapidly spreading best practices. Improvement initiatives include collaborative projects, online interaction and peer-to-peer education.• Greater value is fostered. QIN-QIOs will support CMS’ new value-based purchasing programs with technical assistance to providers that includes sharing best practices, assisting with data analysis and conducting improvement activities.
3 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 organizationBFCC-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.
5 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 organizationBFCC-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.
6 BFCC-QIO SOW – What’s New? Enhancements to the BFCC-QIO SOWFive CMS defined areasEach required to maintain local presenceBusiness hours seven days a weekStaffing to cover the following times in each time zone within the QIO areaMon-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; andMaryland-based LIVANTA for 17 states, the USVI and Puerto Rico
7 BFCC QIO Important Contacts Area AddressToll-Free Number Fax NumberLivanta1Livanta BFCC-QIO Program 9090Junction Drive, Suite 10Annapolis Junction, MD 20701Appeals:All other reviews5Appeals:KEPRO25201 W. Kennedy Blvd., Suite 900Tampa, FL 3360935700 Lombardo Center Dr., Suite 100Seven Hills, OH 441314
8 CMS Quality Strategy: Aligns with NQS and IOM Strategies Make care safer by reducing harm caused in its deliveryStrengthen person and family engagementPromote effective communication and care coordinationPromote effective prevention and treatment of chronic diseaseWork with communities to promote best practicesMake care affordable
10 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 CarePrimaris (Missouri)QIPRO (Puerto Rico)TMF Health Quality Institute (Texas and Oklahoma)TMF Health Quality Institute has partnered with the Arkansas Foundation for Medical Care, Primaris in Missouri and the Quality Improvement Professional Organization, Inc. in Puerto Rico to form the TMF Quality Innovation Network Quality Improvement Organization (TMF QIN-QIO), under contract with the Centers for Medicare & Medicaid Services (CMS). The TMF QIN-QIO works with providers across all care settings to provide quality improvement services in the states of Arkansas, Missouri, Oklahoma and Texas, and the territory of Puerto Rico.
11 TMF QIN-QIO’s Strategies for Change Community Organizing and Coalition BuildingDevelop shared community leadershipDevelop a purpose for the community teamWork with a cross-continuum of providersIdentify the right participants and continuously recruit new membersLearning and Action NetworksA virtual gathering place to communicate with providers, stakeholders and beneficiariesProvide educational events, resources, tools and data portalProvider/ Practitioner Technical AssistanceHands-on assistance with community organizing, root cause analysis, intervention implementation and monitoringProvider-specific education and consultation
12 CMS Goal 1: Promote Effective Prevention and Treatment of Chronic Disease Improving Cardiac Health & Reducing Cardiac DisparitiesReducing Disparities in Diabetes Care: Everyone with Diabetes CountsImproving Prevention Coordination Through Meaningful Use of Health Information Technology (HIT)
13 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 readmissionsMorbidity and mortality data suggests the risks are far greater for racial and ethnic populations than whites
14 The Cardiac ProjectWork with providers and beneficiaries in collaboration with key partners and stakeholdersWork together in a Cardiac Learning and Action NetworkTarget racial and ethnic minority Medicare beneficiaries, dual eligible and providers practitioners who serve themSupport Million Hearts® Campaign: prevent one million heart attacks and strokes by 2017Focus on evidenced-base: ABCS (ASA, BP, Cholesterol, Smoking Cessation)
15 The Cardiac Project: Targeted Providers Home health agenciesParticipate in Cardiovascular Data Registry, Home Health Quality Improvement (HHQI) CampaignPractitioner owned and operated offices and clinicsOther facilities where physician, nurse practitioner, physicians assistant oversight is providedProviders, practitioners required to be Physician Quality Reporting System (PQRS) alignedProviders, practitioners who serve racial and ethnic minorities
16 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).Utilization of health literacy tools to provide educationUtilize the Best Practice Intervention Packages (BPIPs) to provide Technical AssistanceParticipate in cardiac Learning and Action Network activities and share success stories
17 Improving Cardiac Health: Goals Prevent one million heart attacks and strokes – Support Million Hearts® CampaignSpread the implementation of evidence-based practices: ABCSPractice goals by January 2019:70 percent patients blood pressure (BP) controlled, per guidelines70 percent patients screened for tobacco use70 percent identified as smokers receive smoking cessation counseling
18 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 yearsOur current project with African-Americans reveals that only 2.9 percent of those with Medicare and diabetes are utilizing their DSME benefits.The need is great for our state of Texas. As we continue each day on these initiatives we learned more and more about the needs of our citizens. During our first project the strong need for free DSME education and improved access to DSME programs was revealed. We identified that from the time of diagnosis to the time a person with diabetes received any diabetes education is ranging from between 7-13 years.
19 Everyone with Diabetes Counts: The Goals Increase number beneficiaries who complete DSME classesObtain repeated measurements on the same beneficiaries longitudinally over timeHbA1c, lipids, eye exam, BP control, weightDecrease lower extremity amputationsImprove health literacy diabeticsIncrease adherence to clinical guidelines
20 Improving Prevention Coordination with Meaningful Use of HIT (slide 1 of 3) Closes the gap between patient care (diagnostics, etc.) and outcomesComplete, organized patient’s chart in hand at all timesFacilitates implementation of evidence-based best practicesAllows management of patient panelsPromotes transparency
21 Improving Prevention Coordination with Meaningful Use of HIT (slide 2 of 3) Influences improved outcomes with data at the practice’s fingertipsAlerts and reminders for safer patient careeRxing provides more efficient and accurate drug dispensingSupport IT-enabled care management for primary care prevention and early diagnosisImprove specific health care services, processes and health outcomes related to prevention, population health and care coordination
22 Improving Prevention Coordination with Meaningful Use of HIT (slide 3 of 3) Effective use of clinical decision support and quality measurementEligible professionals, hospitals and critical access hospitalsRecruit providers and hospitals with electronic health records (EHRs)Reduce HIT disparitiesTarget most challenged to meet EHR incentives and quality improvement goalsProvide technical assistance and coaching 1-on-1 and virtuallyMonthly reporting and data analysisImprove care team and patient communicationEngage beneficiaries
23 CMS Goal 2: Make Care Safer by Reducing Harm Caused in the Delivery of Care Reducing Healthcare-Associated Infections (HAIs) in HospitalsReducing Healthcare-Associated Conditions in Nursing Homes
24 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, 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,
25 Reducing Healthcare-Associated Infections in Hospitals: The Project Recruit hospitals with Central-Line Associated Blood Stream Infection (CLABSI) rates above national averagesWork in CLABSI, CAUTI and C. diff reduction in both Intensive Care Unit (ICU) and non-ICU settingsVentilator Associated Events reduction educationUse root cause analysis to determine causes of infections and target interventionsEducational webinars tailored to identified causesEducation on reporting National Healthcare Safety Network (NHSN) data
26 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
27 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 OklahomaNational Collaborative, two rounds of recruitmentIndividualized technical assistance to all recruited nursing homesCoaching on initiating a Quality Assurance and Performance Improvement (QAPI) cultureLocal Area Network for Excellence (LANE) convenerEngage beneficiaries
28 Nursing Home Project Goals Reduction in percentage of residents who receive antipsychotic medicationsPercentage of long-stay residents with improved mobilityPercentage of facilities recruited, including low performersAttain composite score of six or better on the Nursing Home Quality Composite Measure (13 National Quality Forum-endorsed long-stay quality measures)
29 CMS Goal 3: Promote Effective Communication and Coordination of Care Care Coordination: Reducing Readmissions
30 Statement of Problem: Readmissions Hospitalizations consume 31 percent of the $2 trillion in total health care expenditures in the United StatesOne in four (25 percent) of hospitalizations are avoidableOne in five (20 percent) of all hospitalizations result in 30-day readmissionsThe chronically ill and frail elderly are the single largest population segment in terms of cost in the US. However, they interact with a health care delivery system that is oriented to acute, episodic interactions. It is the acute, episodic nature of care that is driving the hyper-fragmentation in care delivery, which affects no one more those who rely on continuous interaction with providers- those living with chronic illnesses.You’ll note throughout my comments, I will take a purposefully non-disease specific approach. Much of the work that has been done to understand high rates of rehosptialization and the effectiveness of various approaches to reduce the cycle of rehospitaliziations has been conducted in patients with congestive heart failure. Many of the principles apply broadly. To that end, Massachusetts’ focus on improving the care for patients with DM will undoubtedly go a long way to improving care for patients more generally.Hospitalizations account for almost a third of the $2 trillion in total health care expenditures in the United StatesOf course, in the majority of situations, hospitalizations for acute and serious illnesses are necessary and appropriate;However, research suggests that approximately a quarter of hospitalizations are avoidable and roughly 20% of all hospitalizations are re-hospitalizations, many of which are potentially avoidable.Source: Lynn J, Straube BM, Bell KM, Jencks SF, Kambic RT. Using population segmentation toprovide better health care for all: The “Bridges to Health” model. Milbank Q. 2007;85:
31 Care Coordination: Reducing Readmissions Recruit communities where 60 percent of Medicare Fee-for-Service (FFS) beneficiaries resideProvide one-on-one and virtual technical assistance to hospitals, downstream providers and communitiesEducate on best practices, root cause analysis, implementing interventions, monitoring progress and understanding the dataRecruit and form community coalitionsCoordinate and conduct community workgroup meetings
32 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.1Given 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.2,31Institute 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:3National Action Plan for Adverse Drug Event Prevention. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 2013.
33 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 opioidsUse data to map out barriers and solutionsFocus on medication reconciliation and medication therapy managementShare evidence-based practices and tools with practitioners and patients
34 Care Coordination: Reducing Adverse Drug Events (ADEs) Provide one-on-one and virtual technical assistance to recruited organizations and stakeholders10 percent relative improvement rate (RIR) in percentage of 30-day readmissions per 1,000 FFS beneficiaries in a region- wide coalition7 percent RIR in percentage of admissions per 1,000 beneficiaries in region wide coalitionReduce ADEs in these populations by 50 percent RIR per 1,000 patients by the end of the contract
35 CMS Goal 4: Make Care More Affordable Quality Improvement through Value-Based Payment, Quality Reporting and Physician Feedback Reporting
36 Quality Improvement Value-Based Payment Modifier Target hospitals, inpatient psychiatric facilities, ambulatory surgical care centers, outpatient departments, physicians, physician groups, critical access hospitals, cancer hospitalsAnalyze quality and resource use reportsAssist in improving measuresNetwork with similar facilities for support and best practice
37 TMF QIN-QIO Learning and Action Networks (LANs) Provide targeted technical assistance to participating providers, stakeholders and communities in CMS quality improvement initiativesEngage providers and stakeholders in improvement initiatives through web-based Learning and Action NetworksThe networks serve as hubs for the regional quality improvement work for each project, including:Project information › Data portalUpcoming events › Project maps and dataDiscussion forums › VideosResource library › Recorded eventsLANs convene stakeholders, providers and improvement experts in an “all teach, all learn” model.Through the LAN, the TMF QIN-QIO’s networks provide educational webinars and conferences, encourage peer sharing, rapid testing of change ideas and support for adapting and spreading successful improvements.
38 Learning and Action Networks Cardiovascular Health and Million HeartsHealth for Life – Everyone with Diabetes CountsHealthcare-Associated InfectionsMeaningful Use (Health Information Technology)Medication SafetyNursing Home Quality ImprovementQuality Reporting and Incentive ProgramsQuality Improvement InitiativeReadmissionsCardiovascular Health and Million Hearts – preventing one million heart attacks and strokes by 2017• Health for Life-Everyone with Diabetes Counts –improving health outcomes for people with diabetes and helping eliminate health disparities• Healthcare-Associated Infections – reducing healthcare-associated infections in hospitals• Meaningful Use – improving prevention coordination through meaningful use of health information technology and collaborating with Regional Extension Centers• Nursing Home Quality Improvement – reducing healthcare-acquired conditions and improving the quality of care in nursing homes• Medication Safety – improving drug safety practices, reducing medication-related harm and developing innovative care standards• Quality Improvement Initiative – providing technical assistance to providers and practitioners to help them improve the quality of their care.• Quality Reporting and Incentive Programs – assisting physicians, hospitals and other health care settings with value-based payment and quality reporting programs• Readmissions - reducing avoidable hospital readmissions by improving the quality of patients’ transitions between health care settings
39 TMF QIN-QIO Learning and Action Network: http://www.TMFQIN.org
40 For more information Vanessa Andow, CPHQ Program Manager, Readmissions TMF Quality Innovation NetworkPhone:
41 Questions?It is not the answer that enlightens, but the question… - Eugene IonescoThis 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-C