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11th Scope of Work (SoW)

The New QIO Program

Teresa Titus-Howard, PhD, MHA, MSWQIN-QIO Lead

Melissa Dorsey, MHAQIN-QIO Coordinator 11/12/14

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Agenda

I. 11th Scope of Work (SoW)II. Important ContactsIII. CDC and State RoleIV. Questions

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What Is Our End Goal….

Support a continuously evolving network of dedicated and committed experts in quality improvement,

working together in partnership with multiple entities, patients and families to improve health care, support the creation of healthy people in

healthy communities and lowering costs through improvement.

“To change a nation……..”

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The QIO Program’s Approach to Clinical Quality

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11th Scope of Work (SoW) –Major Changes

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 5 geographic areas across the Nation.

QIN-QIOs will be regional, and could cover anywhere from 3 to 6 states. The QIO contract cycle will be extended from 3 to 5 years.

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How Does CMS Propose to Operate the QIO Program in the Future?

Program Collaboration Center Independent Evaluation Center

QIN NCCBFCC NCC

1) O&E Hospital Inpatient-Psych and

Cancer

BFCC Oversight & Review Center

BFCC 1

BFCC—QIO

BFCC 2

BFCC 5

BFCC 3 BFCC 4

QIN—QIO

Strategic Innovation Center

Value Incentives and Quality Reporting Centers

2) O&E ASC and Outpatient

3) Coordination and Policy Advisory

Contractor 4) M&E /Analytics

5) Validation Support 6) Appeals

Multiple Service Areas covering the

entire country

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Quality Innovation Network (QIN-QIO) Work

QIN NCC

C. Better CareC1. Reducing care-associated infectionsC2. Reducing care-acquired conditionsC3. Coordinating care to reduce readmits & adverse drug events

D. Lower Costs

D1. TA provided to for Physician Value ModifierD2. Local QIO Projects

E. Technical Assistance

- BFCC- VBP

B. Better HealthB1. Improving cardiac health & reducing cardiac disparitiesB2. Reducing disparities in diabetes careB3. Coordinating care through Immunization ISB4. Coordinating prevention through HIT meaningful use

Essential Functions

1. Results-Oriented Quality Improvement Activities2. Community Learning and Action Networks3. Technical Assistance (i.e., QI Experts)4. Integrated Communications

A. Excellence in Operations

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:This information has not been publicly disclosed and may be privileged and confidential.. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

Task B.1

Improving Cardiac Health & Reducing Cardiac Healthcare Disparities

Cynthia Pamon, GTL

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Heart attack and stroke prevention Million Hearts® Support Improve the ABCS

Aspirin therapy as appropriate Blood pressure control Cholesterol management Smoking screening and cessation

Improving Cardiac Health

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Improving Cardiac Health

Recruitment (Clinical and Non-Clinical Participants)

Provider Recruitment Rural, home health, physician offices/clinics, other healthcare facilities

where physician, nurse practitioner and/or physician assistant oversight is provided

Disparities Focus African American, Hispanic, Latino, Asian, Pacific Island beneficiaries Any other racial/ethnic beneficiaries in the state/target community

Relevant stakeholders and partners PQRS EHR reporting offices/clinics HDSP and State and Local Health Departments in the 11th SoW

contract as potential partners.

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Technical Assistance – Home Health Agencies

Best Practice Intervention Packages Home Health Cardiovascular Data Registry “UP Network” - Disparities focus See www.homehealthquality.org

Improving Cardiac Health

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Technical Assistance – All Participants

Facilitate the use of new and/or existing best practices, resources, and protocols

LANs, Webinars, Tele-conferences, face-to-face meetings, site visits

Team-based careData driven improvementActive engagement of patients, partners, and stakeholdersConsultation and educationKnowledge management and sustainment

Improving Cardiac Health

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Cardiac Disparities Focus

Interventions, literature, resources, and tools accounting for race, ethnicity, health literacy levels, language, culture, and gender

Consider the social determinants that may contribute to poor health & outcomes.

Low income Lifestyle, activity level Poor nutrition (by choice, availability, affordability) Other environmental, social, and/or emotional issues affect

compliance and/or adherence. Improving other health conditions (obesity, diabetes, etc.)

Improving Cardiac Health

Task B.2Everyone with Diabetes Counts (EDC)

Sue Fleck, GTL

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EDC Goals

Improve health equity by improving health literacy and quality of care among Medicare and Dually Eligible beneficiaries

Target populations are minority underserved and rural Improving testing for: HbA1c, Lipids, Eye Exams, Foot

Exams, Improve Blood Pressure control and Weight control

Improve actual clinical outcomes Facilitate sustainable diabetes education resources

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EDC Components

Recruitment and education of beneficiaries through diabetes self-management education (DSME) classes

Recruitment and education of physician practices and staff

Recruitment of community and state-level partners/stakeholders

Data collection and analysis Sustainability planning/implementation

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EDC National Partnerships

Centers for Disease Control and Prevention (CDC) American Diabetes Association (ADA) American Association of Diabetes Educators (AADE)

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Resources

For additional information about EDC:www.cmspulse.org

Click on the Community Initiatives tab for EDC data results, best innovations, tool kits, pictures of teaching visual aids and classes

Contact Information:Susan Fleck, RN, MMHSGovernment Task LeaderSusan.Fleck@CMS.HHS.GOV

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11th SoW QIN-QIO Map

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QIN-QIOs (1 of 5)

QIN-QIO States QIO Subcontractors

Great Plains Quality Innovation NetworkTina Georgy, CEO1230 O Street, Suite 120, Lincoln, NE 68508217-352-1060 ext. 4205tgeorgy@cimro.com

KSNDNESD

Kansas Foundation for Medical Care (KS)North Dakota Health Care Review (ND)CIMRO of Nebraska (NE)South Dakota Foundation for Medical Care (SD)

TMFTom Manly, CEO5918 West Courtyard Drive, Austin, TX 78730-5036512-334-1614Tom.manley@tmf.orgwww.tmf.org

ARMOOKTXPR

Arkansas Foundation for Medical Care (AR)Primaris (MO)

Lake SuperiorJennifer Lundblad, CEO2901 Metro Drive, Suite 400, Minneapolis, MN 55425952-854-3306jlundblad@mnqio.sdps.orgwww.stratishealth.org

MNWIMI

Stratis (MN)MetaStar (WI)Michigan Peer Review Organization (MI)

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QIN-QIOs (2 of 5)

QIN-QIO States QIO SubcontractorsTelligen Jeff Chungath, CEO1776 West Lakes Parkway, West Des Moines, Iowa 50266515-440-8519jchungath@iaqio.sdps.orgwww.telligen.org

COIAIL

None

HealthInsight Marc Bennet, CEO6830 W. Oquendo Road, Suite 102, Las Vegas, NV 89118702-385-9933Mbennett@healthinsight.orgwww.healthinsight.org

NMNVORUT

Acumentra (OR)

GMCFDennis White, CEO1455 Lincoln Parkway, Suite 800, Atlanta, GA 30346678-527-3404Dennis.white@allianthealth.orgwww.gmcf.org

GANC

None

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QIN-QIOs (3 of 5)

QIN-QIO States QIO SubcontractorsAtomDawn Fitzgerald, CEO3340 Players Club Parkway, Suite 300, Memphis, TN 381251-800-528-2655dfitzgerald@qsource.orgwww.qsource.org

ALINKYMSTN

Alabama Quality Assurance Foundation (AL)Mississippi Foundation for Medical Care dba IQH (MS)

Mountain Pacific Quality Health FoundationSara Medley, CEO3404 Cooney Drive, Helena, MT 59602406-457-5820smedley@mpqhf.orgwww.mpqhf.org

AKHIMTWY

None

AQIN Theodore Will, CEO1979 Marcus Avenue, Lake Success, NY 11042-1072516-209-5540twill@ipro.orgwww.ipro.org

DCNYSC

Delmarva (DC)The Carolinas Centers for Medical Excellence (SC)

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QIN-QIOs (4 of 5)

QIN-QIO States QIO Subcontractors

WVMI dba Quality Insights John Wiesendanger, CEO3001 Chesterfield Place, Charleston, WV 25304304-346-9864 ext. 2297jwiesend@wvmi.orgwww.wvmi.org

DELANJPAWV

Quality Insights of Delaware (DE)eQHealth (LA)Healthcare Quality Strategies (NJ)Quality Insights of Pennsylvania (PA)

VHQCDonald Glozer, CEO9830 Mayland Drive, Suite J, Richmond, VA 23233804-289-5320dglozer@vhqc.orgwww.vhqc.org

MDVA

None

Qualis HealthJonathan Sugarman, CEO10700 Meridian Ave N, Suite 100, Seattle, WA 98133206-364-9700jonathans@qualishealth.orgwww.qualishealth.org

IDWA

None

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QIN-QIOs (5 of 5)

QIN-QIO States QIO Subcontractors

Health Services Advisory Group (HSAG)Mary Ellen Dalton, CEO313 East Camelback Road, Suite 100Phoenix, AZ 85016-4545602-801-6701mdalton@hsag.comwww.hsag.com

AZCAFLOHVI

None

Healthcentric AdvisorsH. John Keimig, CEO235 Promenade St.Suite 500, Box 18Providence, RI 02908401-528-3238jkeimig@healthcentricadvisors.orgwww.healthcentricadvisors.org

CTMAMENHRIVT

Qualidigm (CT, NH & VT)

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Draft Email to QIN-QIO CEO

Subject Line: QIN-QIO 11th SoW Partnership and Collaboration Opportunities

Dear Mr/Mrs. XYZ,

Congratulations on your recent award of the QIN-QIO 11th SoW. My name is XYZ, from the XYZ State of Department of Health, Bureau of XYZ.

Recently, I attended a Webinar held by CMS Representatives Teresa Titus-Howard, 11th

SoW QIN-QIO Lead and Melissa Dorsey, QIN-QIO Coordinator. The purpose of the Webinar was to provide a broad overview of the 11th SoW and Tasks to all of the State Departments of Health and CDC Representatives.

During the webinar, Dr. Titus-Howard recommended that each State Department of Health reach out to the QIN-QIOs awarded the 11th SoW to discuss opportunities for collaboration; specifically, where our goals are aligned. She mentioned the appropriate person on your team, besides yourself, would be the 11th SoW IDIQ Director and/or State Task Order Directors.

Would it be possible to …………….

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QIN-QIOAssigned CMS Staff

QIN-QIOPrime Contractors

States/ Territories

Subcontractors(Former QIOs*)

Contracting Officer Representative (COR)(e.g. Project Officer at CDC)

1 Great Plains Quality Innovation Network

KS, ND, NE, SD KS QIOND QIONE QIOSD QIO

Claudia Bullock (IDIQ, KS, ND, NE, SD)Claudia.bullock@cms.hhs.gov

2 TMF AR, MO, OK, TX, PR

AR QIOMO QIOOK QIO

Patty Rawlings (IDIQ, AR, MO, OK, TX, PR)Patty.rawlings@cms.hhs.gov

3 Lake Superior Quality Innovation Network

MN, WI, MI MN QIOWI QIOMI QIO

Tim Watson (IDIQ, MN, WI, MI)Timothy.watson@cms.hhs.gov

4 Telligen CO, IA, IL None Marion Broderick (IDIQ, CO, IA, IL)Marion.broderick@cms.hhs.gov

5 HealthInsight NM, NV, OR, UT

OR QIO Jeri McClain (IDIQ, OR, UT)Jerilyn.McClain@cms.hhs.govDianna Wardlow-Dotter (NM,NV)Dianna.wardlow-dotter@cms.hhs.gov

6 GMFC GA, NC None Shalon Quinn (IDIQ, GA, NC)Shalon.quinn@cms.hhs.gov

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QIN-QIOAssigned CMS Staff

QIN-QIOPrime Contractors

States/ Territories

Subcontractors(Former QIOs*)

COR

7 Qsource AL, IN, KY, MS, TN

AL QIOIN QIOKY QIOMS QIOTN QIO

Jeff Mokry (IDIQ, AL, KY, MS, TN)Jeff.Mokry@cms.hhs.govTrevor Stone (IN only)Trevor.stone@cms.hhs.gov

8 Mountain PacificQuality Health Foundation

AK, HI, MT, WY

None Tim Watson (IDIQ, AK, MT)Timothy.watson@cms.hhs.govMarion Broderick (HI, WY)Marion.broderick@cms.hhs.gov

9 IPRO DC, NY, SC DC QIOSC QIO

Mary Ford (IDIQ, DC, NY, SC)Mary.Ford@cms.hhs.gov

10 WVMI dba Quality Insights

DE, LA, NJ, PA, WV

DE QIOLA QIONJ QIOPA QIO

Jefferson Rowland (IDIQ, DE, PA, WV)Jefferson.rowland@cms.hhs.govMalini Krishnan (LA)Malini.krishnan@cms.hhs.govCraig Bagley (NJ)Craig.Bagley@cms.hhs.gov

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QIN-QIOAssigned CMS Staff

QIN-QIOPrime Contractors

States/ Territories

Subcontractors(Former QIOs*)

COR

11 VHQC MD, VA None Mary Wagner-Clarke (IDIQ, MD, VA)Marie.Wagner-Clarke@cms.hhs.gov

12 Qualis Health ID, WA None Jeri McLain (IDIQ, ID, WA)Jerilyn.McClain@cms.hhs.gov

13 Health Services Advisory Group

AZ, CA, FL, OH None Mary Anne Butcher (IDIQ, AZ, CA, OH)maryanne.butcher@cms.hhs.govShalon Quinn (FL)Shalon.quinn@cms.hhs.gov

14 Healthcentric Advisors CT, MA, ME, NH, RI, VT

CT QIO Craig Bagley (IDIQ, RI)Craig.Bagley@cms.hhs.govMei Wang (CT, MA)Mei.Wang@cms.hhs.govEdwin Huff (ME, NH, VT)Edwin.Huff@cms.hhs.gov

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State Health Departments and QIN-QIOs

CDC and States• Key stakeholder and partner• Mutual interest

What can the States do?• Reach out directly to QIN-QIOs • Become familiar with the SoW • Learning and Action Networks• Technical Assistance Guidance and Materials

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Measure ID 11th SoW QIN-QIO Related Task Work

m_3.1.01 Task B.4m_3.1.03 N/Am_3.1.05 Task B.1m_3.1.07 Task B.1m_3.1.09 Task B.1m_3.1.10 Task B.1m_3.1.02 Task B.4m_3.1.04 N/Am_3.1.06 Task B.2m_3.1.08 Task B.3m_3.1.11 Task B.3m_3.1.12 N/A

Measure ID 11th SoW QIN-QIO Related Task Work

m_3.2.01 N/A

m_3.2.03 N/Am_3.2.07 Task B.1m_3.2.09 N/Am_3.2.10 Task B.1m_3.2.02 N/Am_3.2.04 N/Am_3.2.08 Task B.2m_3.2.11 Task B.2m_3.2.12 N/Am_3.2.05 N/Am_3.2.06 N/Am_3.2.07 Task B.1m_3.2.09 N/Am_3.2.10 Task B.1

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QIO Programhttp://qioprogram.org

Questions