Generate, apply and disseminate knowledge to improve the quality of health-care delivery and health outcomes. Generate, apply and disseminate knowl-edge to improve the quality of healthcare delivery and health outcomes. Gen-erate, apply and disseminate knowledge to improve the quality of healthcare delivery and health outcomes. Generate, apply and disseminate knowledge to improve the quality of healthcare delivery and health outcomes. Generate, apply and disseminate knowledge to improve the quality of healthcare delivery and health outcomes. Generate, apply and disseminate knowledge to im-prove the quality of healthcare delivery and health outcomes. Generate, apply and disseminate knowledge to improve the quality of healthcare delivery and health outcomes. Generate, apply and disseminate knowledge to improve the quality of healthcare delivery and health outcomes. Generate, apply and dis-seminate knowledge to improve the quality of healthcare delivery and health outcomes. Generate, apply and disseminate knowledge to improve the quality of healthcare delivery and health outcomes. Generate, apply and disseminate knowledge to improve the quality of healthcare delivery and health outcomes. Generate, apply and disseminate knowledge to improve the quality of health-care delivery and health outcomes. Generate, apply and disseminate knowl-edge to improve the quality of healthcare delivery and health outcomes. Gen-erate, apply and disseminate knowledge to improve the quality of healthcare delivery and health outcomes. Generate, apply and disseminate knowledge to improve the quality of healthcare delivery and health outcomes. Generate, apply and disseminate knowledge to improve the quality of healthcare delivery and health outcomes. Generate, apply and disseminate knowledge to im-prove the quality of healthcare delivery and health outcomes. Generate, apply

Realizing the VisionQualis Health 2006

2 section heading

Dear Friends, This is a tumultuous time in healthcare. But it is also a time of great opportunity for those of us

committed to collectively improving a system that touches the lives of everyone in the nation.

In its landmark 2001 report, Crossing the Quality Chasm, the Institute of Medicine called for

improvements in six healthcare domains: safety, effectiveness, patient-centeredness, timeliness,

efficiency and equity. These improvements are not only possible, the report argued, but are key

national aims for a vital 21st-century healthcare system.

Qualis Health is committed to making these improvements possible through our continued

collaboration with our partners, clients and stakeholders. For example, in 2006 we:

Helped improve healthcare - safety by providing support for the Institute for Healthcare

Improvement’s campaign to save 100,000 lives in America’s hospitals.

S - upported effective care by applying evidence-based care management guidelines in our

utilization review processes and evidence-based interventions with providers as part of

our Medicare Quality Improvement Organization initiatives.

As - sured patient-centered care through our individualized case management programs,

which served thousands of people facing severe illness or injury.

Su - pported timeliness in healthcare decisions by helping physicians caring for Medicare

beneficiaries redesign their care processes and implement electronic medical records.

Pr - omoted efficiency by introducing new information technology that streamlines

utilization review and simplifies the administrative burden on providers.

Work - ed to improve healthcare equity for patients by engaging physicians in cultural

competency training and helping communities complete healthcare disparities analyses.

During 2006 we also focused considerable attention on enhancing our own organizational

effectiveness by committing to integrate the Malcolm Baldrige National Quality Program’s

framework into our practices, and by examining and modernizing our governance processes.

Since 1974, Qualis Health has been a respected and trusted organization in the healthcare

community. Throughout these past 32 years, we have continued to grow, innovate and

collaborate to maintain that respect and trust. We’re proud of the role we played during 2006

to help every segment of the healthcare system vastly improve the delivery of high-quality

healthcare. We look forward to working with you to build on these achievements.

Sincerely,

Jonathan R. Sugarman, MD, MPH

President and CEO

Qualis Health

Mission generate, apply and disseminate knowledge to improve the quality of healthcare delivery and health outcomes.

Vision Be recognized for leadership, innovation and excellence in improving the health of individuals and populations.

CoRe Values integrity & Professionalism Collaborationstewardship

BetteR systeMs leaD to BetteR outCoMes.

Cultivating Quality by improving systems of Care Qualis Health is charged with improving care delivery

to Medicare beneficiaries in Washington State and Idaho

through its Medicare Quality Improvement Organization

contracts with the Centers for Medicare & Medicaid Services

(CMS), an agency of the U.S. Department of Health and

Human Services (DHHS).

To accomplish this, we work closely with hospitals,

physician offices, nursing homes and home health agencies

– the places Medicare enrollees most commonly visit for

their healthcare needs. Recognizing that these providers

and community partners face different challenges associated

with their unique local environments, we use up-to-date

methodologies and technology and convene organizations

to help healthcare providers improve their quality of care,

efficiency, reporting and compliance. “We are masters

of building effective community coalitions,” says

Michelle O’Neill, Vice President of Medicare Operations

for Qualis Health.

As part of our CMS contracts, we also help safeguard

the integrity of the Medicare trust fund by making sure

that Medicare only pays for medically necessary services

and by investigating beneficiaries’ complaints about the

quality of their care.

WoRking togetheR to iMPRoVe MeDiCation ManageMentA very important aspect of ensuring that Medicare

beneficiaries receive safe and effective care is the

appropriate use of prescription drugs, since determining

the proper medication and dose for elderly patients

can be challenging.

As part of our CMS contracts, we established a five-

state medication-planning network in 2006, which

includes Washington, Utah, Idaho, Nevada and Oregon.

The network’s project includes conducting a detailed

assessment of Medicare Part D and forging partnerships

with prescription drug plans and medication therapy

management services. A crucial goal is determining how

best to ensure the safe and appropriate management of

Medicare beneficiaries’ medications.

PRoViDing CultuRal CoMPetenCy tRaining FoR PhysiCiansProviding care for a more culturally and linguistically

diverse population presents a challenge to patient-

provider communication, which must ensure that patients

understand and adhere to their care plans.

2 Medicare Medicare 3

During 2006, Qualis Health promoted an educational

resource designed by the federal Office of Minority Health

(OMH) to help physicians deliver the best quality of care

possible to patients from diverse backgrounds.

We developed a white paper in collaboration with

Physicians Insurance (a malpractice insurer) that made

a business case for cross-cultural communication as

a risk-management issue. We distributed the paper to

our primary care physician mailing list, all Physicians

Insurance policyholders, attendees at a national cultural

competency conference and policy planning groups,

such as the Washington State’s Blue Ribbon Commission

on Health Care Costs and Access and the Governor’s

Interagency Council on Health Disparities.

helPing nuRsing hoMe ResiDents aVoiD PRessuRe ulCeRs Pressure ulcers are painful and often life-threatening for

nursing home residents. To address this serious health

threat, Qualis Health convened the Idaho Pressure Ulcer

Prevention Coalition, which includes representatives from

Qualis Health, nursing homes, home health agencies and

hospitals and a physician specializing in wound treatment.

Working with providers and community partners in 2006,

the coalition conducted well-attended workshops across

Idaho that focused on pressure ulcer prevention. The

Qualis Health improves systems to ensure the best care for Medicare beneficiaries.

Idaho nursing homes that worked very closely with Qualis

Health achieved outstanding results. Thanks in part to the

coalition’s work, the rate of pressure ulcers for high-risk

nursing home residents decreased by 21.9 percent (from

9.1 percent to 7.1 percent).*

Qualis Health also worked extensively on pressure ulcer

management with 31 nursing homes in Washington. This

resulted in a 17.9 percent decrease of pressure ulcers among

high-risk residents (from 12.5 percent to 10.3 percent).*

Washington state

Use of physical restraints

with nursing home residents

decreased by 31.3% (from

2.8% to 1.9%).*

Appropriate use of

antibiotics for surgical

infection prevention in

hospitals improved by 13.7%

(from 75.3% to 85.6%).*

idaho

Long-term care nursing home

residents reporting moderate

to severe pain decreased by

37.3% (from 9% to 5.6 %).*

Smoking cessation counsel-

ing for patients admitted to

hospitals with pneumonia,

heart failure and heart attack

increased by 13.2% (from

78.8% to 89.2%).*

* Go to www.qualishealth.org/annualreport for data analyses associated with these findings.

Through our suite of care management services, Qualis Health provides

nationally recognized utilization, case and disease management for three market

sectors: workers’ compensation, Medicaid and self-funded health plan clients.

Care management supports our mission to generate, apply and disseminate

knowledge to improve the quality of healthcare delivery and health outcomes by

helping individuals obtain the best possible care while minimizing unnecessary

and wasteful spending.

ResPonsiVe utilization ReVieWOur team of nurse reviewers is the heart of Qualis Health’s well-respected

utilization review programs. They work in concert with on-site medical directors

who specialize in a wide range of areas, including critical care, family medicine,

rehabilitation, neurosurgery and pulmonary medicine. The review team analyzes

complicated cases – including those involving traditional, experimental and

alternative therapies – through a standardized, evidence-based approach.

Operating under nationally recognized clinical guidelines and established

business rules, our utilization review professionals provide consistent and

objective evidence-based recommendations.

As we evaluate the necessity and advisability of a hospitalization or medical

procedure, we ask this basic question: For this patient, is this the right care at

the right time in the right setting? During 2006, we recommended in-home

and community-based care for many patients, helping them avoid 10,287

hospital days and 897 unnecessary procedures, as well as the risks associated

with hospitalization. For our clients, this meant both improving health and

saving resources.

improving healthcare, one Patient at a time skilleD anD Patient-CenteReD Case ManageMentWith their years of training, experience and expertise, our

case managers assist thousands of seriously ill and injured

patients every year. We help these patients access the

services they need and navigate the challenging maze that

is the American healthcare system.

In 2006, the Washington State Health Insurance Pool

(WSHIP) awarded us a care management contract. WSHIP

provides health insurance coverage to more than 3,100

residents in the state of Washington who have been denied

coverage. These patients, with major medical problems,

will benefit greatly from our work with WSHIP, which

began in early 2007.

inCReaseD eFFiCienCy helPs eliMinate Waste With an ever-increasing number of clients, patients

and providers, we strive to meet our clients’ needs as

quickly as possible. According to Marci Weis, Qualis

Health Vice President of Care Management, “Our goals

are to expand technology to make care management more

efficient, lower administrative burdens and bring greater

value to those we serve.”

To do so, Qualis Health uses the Lean philosophy and

methodology of change. Some refer to Lean as a “thought

revolution,” as it transforms organizational culture as much

as it changes practices.

4 Care Management Care Management 5

a commitment to collaboration

April, a single mother on Medicaid with gestational diabetes, renal

insufficiency and acute leukemia, suffered a stroke while 25 weeks

pregnant. Four weeks later, while undergoing chemotherapy, she

delivered her baby boy prematurely. April and her son faced major

medical problems and she struggled to manage day to day.

To adequately help April, her Qualis Health case managers

collaborated to develop a patient-centered plan. Before April moved

back to her home state, they educated her family about the care she

and her baby would need. They made sure her Medicaid coverage

successfully transferred and that she and her son would continue

receiving appropriate care in the right setting. They even helped

coordinate her travel. Thanks to all this support, April was able to

follow her providers’ suggestions. Through everyone’s collaborative

efforts, April and her baby achieved better personal and health

outcomes, and the Medicaid program saved a significant amount

of money.

our reach

In 2006, we handled 72,093 calls to

our care management call lines.

our impact

We completed 48,640 utilization

reviews and saved clients more than

$21 million.

We managed 2,919 cases

and saved clients more than $6 million.

provider praise

Excellent customer service. Efficient, quick

responses to utilization reviews. Fair

arbitrators. A professional, well-trained

staff. Excellence in providing education and

recognizing differences between rural and

larger hospitals. Nurse reviewers who com-

municate in a thorough and timely fashion.

One component of Lean is the Rapid Process Improvement

Workshop (RPIW). Last year, Qualis Health’s Care

Management department completed several RPIWs,

which provided staff with a roadmap to significantly

reduce errors, costs, space, labor, time and steps. Lean

principles and RPIWs will continue to help Qualis Health

transform the way our Care Management department

provides service.

the Right CaRe at the Right tiMe in the Right setting.Qualis Health helps individuals receive the best possible care as efficiently and cost-effectively as possible.

At Qualis Health, we never lose sight of our clients’ needs

and constantly strive to provide the highest quality of

service. We do so by responding to our clients’ comments

and suggestions and by studying emerging issues to

ensure that we can help our clients respond quickly and

creatively to new developments. As Michael Garrett,

Vice President of Business Development, explains,

“The outcomes of our work are testimonials to how

well we meet our clients’ needs.”

neW Clients Qualis Health provided new or expanded services in

2006. The Washington Counties Insurance Fund (WCIF)

awarded us a contract to provide utilization management,

case management and specialty review services to

the 4,050 enrollees in WCIF’s Washington Counties

Insurance Pool Plan.

We were also selected to provide these services for the

Alaska Carpenters Health and Welfare Trust Fund, the

Puget Sound Electrical Workers Health and Welfare Trust,

and the Washington State Health Insurance Pool. Our

role in these healthcare plans builds on our reputation for

high quality and continues our efforts to provide superior

services that meet our clients’ care management needs.

outlook assoCiatesOne key area of growth in 2006 was healthcare

information technology, due in part to our December 2005

acquisition of Outlook Associates, a healthcare information

systems and operations improvement consulting firm.

By combining our capabilities with those of Outlook

Associates, we can help our clients move into the future

of healthcare information technology and healthcare data

exchange to ensure their access to timely and accurate data

on which to base sound clinical and business decisions.

sharing information throughout a region

expanding services 76 expanding services

exploring opportunities and expanding services

The Long Beach Network for Health (LBNH) is a coalition of health-

care organizations that includes hospitals, medical centers and

groups, health plans, a healthcare consulting group, the City of Long

Beach Department of Health and Human Services and the Los Ange-

les County Department of Health Services. Their goal is developing

a regional information exchange infrastructure that will mature into

a Regional Health Information Organization (RHIO). The system will

facilitate the exchange of information so that those treating any one

person in a variety of settings have all the information they need to

provide informed, appropriate care.

The LBNH identified the need for improved healthcare quality and

continuity of care for area residents. They wanted a sustainable mod-

el that would improve access to and use of relevant clinical data.

To accomplish this, the LBNH contracted with Outlook Associates

to assess community needs for sharing healthcare information,

evaluate the status of the Health Information Systems (HIS) facilities

that might participate in a pilot project and recommend strategies

for constructing a health information exchange (HIE) infrastructure.

Outlook Associates conducted an assessment in the summer of

2006 that documented LBNH participants’ ability to support HIE

needs and a specific technical architecture. They recommended de-

veloping an HIE to meet priority physician health data needs, includ-

ing medications, laboratory results, discharge summaries, radiology

interpretations, discharge diagnoses and physician consults.

“Systems and technology are essential tools in quality

healthcare – they can put critical patient information,

diagnostic test results and clinical research at the fingertips

of the clinician whenever and wherever they are needed.”

Pat Lohman, President of Outlook Associates, LLC

tiMely inFoRMation leaDs to neW solutions. Qualis Health studies emerging issues and provides products and services to address them.

Experts estimate that nearly one-third of the medical tests

performed in the United States each year are redundant.

The results from these tests already exist, usually in

patients’ primary care medical records. But specialists or

emergency departments have no way of accessing these

records. As a result, they repeat tests, which raises medical

costs without any additional benefit to patients.

This is just one of the many problems in healthcare

management today. Qualis Health has been a leader in

helping clients create solutions to problems like this one

by using technology in innovative ways that improve the

quality and efficiency of care while lowering costs.

BalanCing PRiVaCy With eFFiCienCy One example of our assistance with technology challenges

is our role with Washington state’s Health Information

Security and Privacy Collaboration (HISPC). HISPC is

a national, collaborative effort launched to address the

privacy and security policy questions that affect health

information exchange. Currently 34 selected state entities,

including Washington state, are charged with bringing

together a broad range of stakeholders to develop solutions

information technology 98 information technology

Maximizing technology increases Value, efficiency to problematic variations in privacy and security business

practices. The goal is an interoperable nationwide health

information network. The hope is that this effort will

transform the healthcare system by demonstrating how

electronic information exchange can be used without

compromising the privacy and security of patients’

sensitive information.

Washington State Governor Christine Gregoire selected

Qualis Health in mid-2006 to lead the state’s HISPC efforts,

a selection she based on our leadership in employing

technology to effectively serve healthcare needs. We are

working with a group of Washington state experts and

stakeholders to resolve the relevant policy issues. Then, we

will turn our attention to implementing solutions.

helPing Mental health seRViCes aDaPt to the FutuReAnother example of using technology to unite high-quality

patient care with administrative efficiency is Outlook

Associates’ work with the Los Angeles County Department

of Mental Health to develop the Integrated Behavioral

Health Information System (IBHIS). Once in place,

IBHIS will automate patient records and ease the work of

iMPRoVing Quality. loWeRing Costs.Qualis Health is using information technology to revolutionize the health care industry.

introducing ieXchange

During 2006, Qualis Health

expanded our use of informa-

tion technology to help our

clients make care management

more efficient. We introduced

them to iEXCHANGE™, a HIPAA-

compliant, user-friendly, Web-

based utilization management

product from MEDecision.

iEXCHANGE provides Qualis

Health staff and healthcare

providers with a streamlined,

two-way link that speeds up

the utilization review process,

minimizing paper work, phone

calls and faxes.

Using iEXCHANGE, providers

and payers can enter, preview

and submit their utilization

review requests, print them

out for patient files, and review

and request updates. Patients

receive approval or disapproval

for pending hospitalizations or

procedures much more

quickly. This technology

reduces the administrative

burden on providers and gives

patients greater certainty

and better care.

The response to this new

technology has been

overwhelmingly positive.

One provider commented,

“I was really excited about

getting iEXCHANGE and being

able to streamline the process

of reviewing.” Another said,

“Things are going great! The

staff really love the program;

it is user-friendly and saves

them time.”

clinicians by providing tools to improve intake assessment,

service delivery, reporting and treatment planning.

The Outlook team helped L.A. County create a

comprehensive picture of its current work. Using

information from 188 interviews with clinicians, staff

and leadership, it helped 36 work groups map all client

service delivery patterns and procedures. Now, Outlook

is helping the county’s 50 provider sites move to a robust

functionality. This includes a system that allows hospitals

and physicians to share vital patient information that

informs treatment decisions and provides field support

resources in the event of an emergency.

The role of a board in governing an organization such as Qualis Health is critical.

Our board is an important part of why we are a national leader in the field of healthcare

quality and innovation.

CReating anD FulFilling goVeRnanCe stanDaRDsIn 2002, Congress passed the Sarbanes-Oxley Act, which focused attention on

organizational governance for private sector companies in a range of industries – including

healthcare – and established guidelines for financial operations and corporate governance.

Sarbanes-Oxley did not, however, cover nonprofit organizations. In 2005, the American

Health Quality Association (AHQA), the national organization for Quality Improvement

Organizations, released its own Standards for Organizational Integrity of AHQA

Institutional Members. This important step came during Qualis Health’s CEO Jonathan

Sugarman’s tenure as AHQA president.

During 2006, thanks to the leadership of our board of directors, Qualis Health completed

the work necessary to meet the new AHQA standards. The board initiated a systematic

process to assess our organizational operations in six areas: board structure, composition

and independence, compensation of board members, executive compensation, travel

expenses and conflicts of interest. In addition, the board commissioned audits and

reviews by three outside experts and developed or revised policies in specific areas based

on the results.

Several changes occurred at the board’s direction. We expanded the level of detail we

include in our annual conflict-of-interest disclosure procedures. We introduced additional

steps to assure that approaches to executive compensation adhere to the highest standards

for nonprofit organizations. And we strengthened annual compliance reviews related

to board structure and function. These efforts, and the commitment of our board,

continue to assure our clients and communities of our commitment to strong governance,

stewardship and accountability.

gooDByes“This year we said goodbye to two outstanding board members: Marie V. Sonderman, RN,

and Robert F. Valliant.

“Marie, who left the board in August, knows how easy it is to get distracted by the science and

lose an important connection with those who utilize the healthcare system. As a strong voice for

consumers, Marie provided the board with valuable guidance over her years of board service.

“Bob passed away in late 2006. He was a quality human being and community treasure. As a

healthcare CEO who worked with boards himself, he brought his unique wisdom and perspective

to ours for 10 years. We will miss him dearly.”

Rick Rubin, Qualis Health Board Chair

guiding Qualis health toward excellence2006 Qualis health board of directors

Rick Rubin, Chair

Bobbie Berkowitz, PhD, RN,

CNAA, FAAN, Vice Chair

Robert S. West, MD,

Secretary/Treasurer

Robert Djergaian, MD

Ralph A. Forquera, MPH

Billie Lewis, RN

William M. McKee, MD, FACP

Jeffrey Partnow, MD

Marie V. Sonderman, RN, BSN

Gilbert W. Thurston

Robert F. Valliant

10 governance governance 11

RiCk RuBin, ChaiRRick Rubin, CEO for OneHealthPort,

a collaborative health information

security company, brings 30 years

of healthcare experience to his role

as board chair of Qualis Health.

Rick has an in-depth perspective on

healthcare markets, information and policy. He is a writer

and speaker on a variety of healthcare topics and also

testifies before government agencies.

“Qualis Health’s staff do a great job of providing scientific,

clinical and real world applications to the industry,”

explains Rick. He cites their highly praised implementation

of the current Medicare QIO Program requirements and

their efficiency improvements using creative technology,

such as iEXCHANGE.

As chair, Rick is committed to ensuring that Qualis Health

meets its goals and mandates. He believes that it is healthy

for an organization and its board to examine their own

functioning. “We benefit from regular organizational

reviews and audits. We will continue to use the findings

to improve our policies and procedures in areas such as

organizational structure, documentation, corporate policies

and board diversity.”

BoBBie BeRkoWitz, PhD, Rn, Cnaa, Faan, ViCe ChaiR Bobbie Berkowitz, vice chair, has

applied her considerable healthcare

expertise to the Qualis Health

board for nearly eight years. Bobbie

is currently the Alumni Endowed

Professor of Nursing, Psychosocial & Community Health

in the School of Nursing at the University of Washington

and adjunct professor in the Department of Health Services

in the School of Public Health and Community Medicine.

Bobbie’s many honors and awards include membership in

the Institute of Medicine (IOM), the American Academy

of Nursing, and National Scientific Bodies of the National

Academies of Science. She applies her extensive experience

with innovative health information technology, including

privacy and security issues, to her board work. By virtue

of her participation on a recent IOM panel that extensively

reviewed approaches to performance measurement and

improvement, she has a unique perspective on Qualis

Health’s effectiveness in the healthcare industry.

“Qualis Health is a well-structured system that understands

both the business and mission of healthcare and solid

strategic planning,” says Bobbie. “We offer our unique

services to the betterment of the healthcare industry and

the patients it serves.”

MeDiCaRe Centers for Medicare & Medicaid Services (CMS)

QIO for Washington State and Idaho -

Communications QIO Support Center -

Performance Improvement QIO Support Center -

MeDiCaiDWashington - State Department of Social and Health Services, Health and Recovery Services Administration

I - daho Department of Health and Welfare, Division of Medicaid

A - laska Department of Health and Social Services, Division of Health Care Services

WoRkeRs’ CoMPensationW - ashington State Department of Labor and Industries

C - omprehensive Risk Management

otheR goVeRnMentW - ashington State Office of the Insurance Commissioner

Or - egon Department of Human Services, Health Promotion and Chronic Disease Prevention Program

Qualis health at a glance

12 Financials Financials 13

selF-FunDeD health PlansAl - aska Laborers

A - laska Teamster-Employer Welfare Trust

C - arpenters Health and Security Trust of

Western Washington

F - airbanks North Star Borough and North Star Borough School District

N - orthwest Roofers and Employers Health and Security Trust Fund

P - ublic Employees Local 71

P - uget Sound Electrical Workers

R - BMS, LLC

W - ashington Fire Commissioners Association

W - ashington Employers Trust

W - elfare and Pension Administrative Service, Inc.

outlook assoCiates ClientsLos Angeles County Department of Mental Health -

LifeMasters -

Long Beach Network for Health -

Physician Associates -

AltaMed Health Services Corporation -

TransforMED, Inc. -

Zenith Administrators, Inc. -

soMe oF ouR 2006 Clients anD ContRaCts:

loCationsSeattle, Washington

Boise, Idaho

Anchorage, Alaska

Tustin, California

leaDeRshiP

Jonathan Sugarman, MD, MPH

President & CEO

Joni Chenoweth

Corporate Director, Human Resources

Michael B. Garrett, MS, CCM

Vice President, Business Development

Patricia Lohman

President, Outlook Associates, LLC

Michelle O’Neill, RN, MSN, MBA, PhD

Vice President, Medicare Operations

Mary Sellers

Chief Information Officer and Vice President

of Information and Communication Services

Robin L. Shuler, CPA, MBA

Vice President, Finance and Administration

Marci Weis, RN, MPH, CCM

Vice President, Care Management

201 Qualis Employees

282 Physician/practitioner

consultant (P/PC) network

members

77 Clients total

35 Government clients

(federal, state, county,

borough, city)

42 Non-government clients

Seattle

Boise

Tustin

Anchorage

FinanCials

Gross Contract Revenue

for Fiscal Year 2006 of

$23,439,210:

Medicare 46% Medicaid 26% Other government 14%Non-government 14%

14%

14%

26%

46%

Medicare

Medicaid

Other government

Non-government

Qualis health’s healthCaRe ConFeRenCes on Quality iMPRoVeMentOur goal is a effective, patient-centered, timely, efficient

and equitable healthcare system. To support that ambition,

Qualis Health held two annual conferences in 2006 to

share innovations with providers, payers and policy leaders

and to honor excellence in healthcare.

Idaho

Aligning People, Money and Information Technology to Improve

Care, held in Boise in April 2006, included speakers

from Quality Partners of Rhode Island, the Institute for

Healthcare Improvement, the Department of Veterans

Affairs National Center for Patient Safety, the National

Business Coalition on Health and Clinica Campesina

Family Health Services. We presented our Award of

Excellence in Healthcare Quality to these Idaho providers:

Clearwater Health & Rehabilitation, Orofino -

Gooding County Memorial Hospital, Gooding -

Guardian Home Care & Hospice, Nampa -

St. Luke’s Magic Valley Regional Medical Center, -

Twin Falls

Mercy Medical Center, Nampa -

St. Joseph Regional Medical Center Home -

Health, Lewiston

Washington

Transformational Strategies for Quality Improvement in

Healthcare, held in Seattle in July 2006, included speakers

from the Washington State Health Care Authority, the

Center for Health Care Strategies and Group Health

Cooperative of Puget Sound. We presented our Award of

Excellence in Healthcare Quality to these Washington

state providers:

Children’s Hospital & Regional Medical Center, Seattle -

Northwest Kidney Centers, Seattle -

Providence Hospice & Home Care of -

Snohomish County

Sound Family Medicine, Puyallup -

S - wedish Physicians, Seattle

sharing innovation and honoring leadership

14 innovation & leadership innovation & leadership 15

CoMing togetheR to iMPRoVe Quality oF CaReThe Idaho Health Quality Planning Commission

The Idaho legislature in 2006 mandated the creation of

the Commission, which includes four hospital leaders, two

physicians, two clinic leaders, two health plan leaders and

an employer representative. The Commission’s main role

is exploring the possibilities of developing a state health

information exchange, including electronic health records,

quality reporting and epidemiological tracking. Qualis

Health is considered a key healthcare resource in the state,

and though not a member of the Commission, our Idaho

medical director participates in its work as a well-respected

expert in the area of quality improvement.

The Washington Health Information Collaborative

The Washington Health Information Collaborative (WHIC)

helps organizations around the state implement healthcare

quality improvements. Qualis Health sponsors this public-

private partnership along with First Choice Health, the

Washington State Health Care Authority (HCA) and the

Puget Sound Health Alliance. In 2006, WHIC distributed

$1 million contributed by First Choice and HCA for the

acquisition, implementation and expansion of health

information technology by healthcare providers. Qualis

Health and Outlook Associates staff provided technical

support to grantees.

Qualis health suPPoRts Quality iMPRoVeMent oRganizationsOur widely recognized quality improvement expertise

positions us to provide leadership and support to the QIO

Program at a national level.

QIO Support Center for Communications

The Support Center team guides Medicare QIO Program

communications at the national level. We work with

CMS to strategically plan and promote national initiatives

and feature accomplishments that further the goal of

improving healthcare quality. We directly support the QIO

community by providing assistance, staffing a national help

desk, and maintaining a clearinghouse of QIO materials,

communications resources, Medicare communications

guidelines and more.

QIO Support Center for Performance Improvement

CMS has charged the team with helping other QIOs

learn and apply improvement methodologies and bringing

them together to learn from one another. Qualis Health

facilitates mentoring among QIOs to help transfer skills

and information on a number of quality measures,

such as security awareness training and improving

home healthcare.

guided by malcolm baldrige principles

Qualis Health submitted an application to the Washington State

Quality Award (WSQA) program in October 2006. WSQA is dedicated

to helping organizations achieve superior results through using the

Baldrige Criteria for Performance Excellence.

We undertook this competitive application process to measure

ourselves against other organizations and to evaluate our own

operations. We examined our governance, strategic planning and

accountability practices. We addressed our efforts to create

diversity and attract and retain an excellent staff. Our application

described how we use new technology to benefit our clients and

stakeholders and how we continually measure and analyze our work

for continuous improvements.

The application reflects our successful efforts to act on our core val-

ues, provide leadership, demonstrate social responsibility in our field

and focus on the future. We look forward to continuing this process

with WSQA during 2007.

People go to the hospital

expecting safe, quality care.

But as many as 98,000 people

die unnecessarily in U.S. hos-

pitals each year. In response,

the Institute for Healthcare

Improvement (IHI) initiated

the “100,000 Lives Campaign”

in 2004 to cut in-hospital

mortality. Qualis Health was

one of the first QIOs to become

involved in the campaign and

worked to enlist hospitals in

Washington, Idaho and Alaska.

In fact, Washington was the

first state of its size to

have 100 percent hospital

participation.

In 2006, we saw the results of

the campaign: a reduction of

122,300 deaths nationwide,

including 1,500 in Washington

state alone. Qualis Health

looks forward to the next step:

reducing harm experienced by

hospital patients through the

IHI “5 Million Lives Campaign.”

the 100,000 lives campaign: some is not a number. soon is not a time.

section heading 19

The world has seen significant healthcare advances over

the years. Research and treatment protocols have improved

the ability to more effectively treat cancer, heart disease

and a host of other serious illnesses. Patients live longer,

benefit from new medications and experience effective,

less invasive treatments. Of equal importance are advances

in the timeliness of medical decision-making, the use of

technology to efficiently meet clinical needs and the quality

of care patients receive from trusted providers.

Qualis Health is proud to be a leader in enhancing quality

and delivery systems for patients and providers alike.

We’re proud of the role we’ve played in preventing

hospital deaths and improving care in nursing home and

home healthcare settings. 2006 brought us great success

as we enhanced care management and helped providers

with secure access, more quickly and efficiently than

ever before, to comprehensive patient information. We’re

committed to continuing this progress as we work with

healthcare providers and our community partners to

realize the vision of a 21st-century healthcare system based

on quality, efficiency and compassionate care.

Realizing the VisionIn the coming year we will implement new care

management contracts with a diverse array of clients,

including South Carolina Medicaid, WSHIP and the San

Francisco Health Plan (SFHP), a California Medi-Cal

insurer program.

We will continue building on our successful

implementation of the Medicare QIO program’s current

priorities, and will develop an equally high-quality

workplan to meet the program’s future requirements, due

for release in 2007. We will continue to apply the Malcolm

Baldrige quality framework for performance excellence to

improve our organizational effectiveness.

Safety, effectiveness, patient-centeredness, timeliness,

efficiency and equity: These goals form our shared vision

for healthcare in 21st-century America. This is the vision

we will strive to realize as we continue collaborating

with patients, families, providers, payers and other

strategic partners.

16 Conclusion

this material was prepared by Qualis health, the Medicare Quality improvement organization for idaho and Washington, in part under contract with the Centers for Medicare & Medicaid services (CMs), an agency of the u.s. Department of health and human services. the contents presented do not necessarily reflect CMs policy.

Qualis health

Corporate headquarters

Po Box 33400

seattle, Wa 98133-0400

TEL (206) 364-9700 or (800) 949-7536

FAX (206) 368-2419

EMAIL info@qualishealth.org

WEB www.qualishealth.org