1. The QIO 9th Scope of Work: A Content Overview
Paul McGann, MD
Deputy Chief Medical Officer
QualNet 2007
23 October 2007
Baltimore, MD

2. The QIO Program has been Re-designed
Framework for Accountability
Content

3. 9th Scope of Work: CONTENT 4 Themes
Prevention
Patient Safety
Care Coordination
(Patient Pathways)
4. Beneficiary Protection

4. Our Goals are to help providers prevent illness, decrease harm to patients, and reduce waste in healthcare

5. Outline Old Work vs New Work National vs Subnational
Process of Development
Design Principles
Content of the Proposed Statement of Work
Perspectives on the Scope
Old Work vs New Work
National vs Subnational
Special Projects
QIOSC-like entities
Evaluation-Attribution
Summary

6. GOALS Provide a content overview
Explain how the “business model” changes how we do our work
Recognize the importance of competition and efficiency
Emphasize the importance of measurement
How are we relevant to CMS and HHS?

7. 9th Scope of Work History
Priorities of the Secretary of Health
Recommendations from External Stakeholders
What do QIOs do well?
What can we measure well?
What is important?
What interventions are backed by evidence?
Recommendations from the QIO Community, and from the Department of Health and Human Services (DHHS)

8. 9th Scope of Work History
Workgroup 1: QIO/CMS Community
Workgroup 2: DHHS
CMS
ASPE (NORC Contract)
ASRT
AHRQ
CDC
OCR
OGC OL OS

9. 9th Scope of Work Overarching Design Principles
More Effective Management
Measurement with Accountability
Relevance to CMS and to HHS
Value-Driven Health Care
Disparities Reduction
Health Information Technology
Careful Evaluation with Attribution

10. 9th Scope of Work: CONTENT 4 5 Themes
Prevention
Patient Safety
Care Coordination
4. Beneficiary Protection
5. Evaluation

11. 9th Scope of Work Levels of Understanding
Less detail
4 Themes (+Evaluation)
10 “Components”
31 “Final Measures”
44 “18 & 28-month Measures”
2-300 “Detailed Measures”
More detail

12. 9th Scope of Work Component Level
Prevention (3)
“Core”
CKD (chronic kidney disease)
“Focused Disparities”
Patient Safety (5)
Pressure Ulcers
Physical Restraints
SCIP
MRSA
Drug Safety
Care Coordination (1)
Beneficiary Protection (1)

13. 9th Scope of Work Measure Level (1)
PREVENTION (10 measures)
“Core”
Mammography
CRC Screening
Influenza Vaccination
Pneumococcal Pneumonia Vaccination
CKD
Screening for nephropathy
ACE/ARB therapy to prevent progression
AV Fistula rate (new dialysis pts)
“Focused Disparities”
HbA1c rates
Lipid Examination rates
Eye exam rates

14. 9th Scope of Work Measure Level (2)
Patient Safety (14 measures)
MRSA 1 (infection rate)
MRSA 2 (transmission rate)
PrU1 (high-risk, NH)
PrU3 (hospital, acquired)
Physical Restraints (NH)
SCIP Infection 1, 2, 3, 4, 6, 7
SCIP VTE 1,2
SCIP Cardiology 2
Care Coordination (3 measures)
Global Re-hospitalization rate
Pt assessment of hospital discharge performance (H-CAHPS items 17, 19, 20)
Physician visit post discharge, before re-admission
(within 30 days)

15. 9th Scope of Work Measure Level (3)
Beneficiary Protection (4 measures)
Timely completion of case reviews
Beneficiary satisfaction with complaint process
Completion of satisfaction survey
% QIA completion

16. 9th Scope of Work Measure Level
Total 31 final outcome measures
With 18-month evaluation requirement, add 13 more measures, for total of 44 “high-level” measures
Management Information System

17. 9th Scope of Work Levels of Understanding
Less detail
4 Themes (+Evaluation)
10 “Components”
31 “Final Measures”
44 “18 & 28-month Measures”
2-300 “Detailed Measures”
More detail

18. 9th Scope of Work “Detailed” Measure Level
Tables have been created from the Schedule of Deliverables
Quarterly and monthly frequencies
Will be used by CMS Central Office and Regional Offices for active contract management
Goal is to detect and to understand difficulties before they become evident at the “Outcome Measure Level”
Early intervention can help avoid adverse consequences

19. 9th Scope of Work Levels of Understanding
Less detail
4 Themes (+Evaluation)
10 “Components”
31 “Final Measures”
44 “18 & 28-month Measures”
2-300 “Detailed Measures”
More detail

20. Ways to think of the 9th Scope of Work
“Levels”
4 Themes to 44 Measures, and beyond…
Topic-oriented (not setting oriented)
Cross-cutting themes (HIT, disparities, VDHC)
Outcomes-oriented: 31 Measures
Patient-Centered:
245,000 more pts screened for CKD
40,000 less pressure ulcers
20,000 more adult immunizations given
What will change? (old work vs. new work)
What will not be “automatic”?
(“National” vs. “Subnational”)

21. Old Work vs. New Work theme by theme (1)
PREVENTION:
Mammography, Influenza Vaccination Pneumococcal Pneumonia Vaccination
Colorectal Cancer Screening
Chronic Kidney Disease
Focused Disparities Reduction

22. Old Work vs. New Work theme by theme (2)
PATIENT SAFETY
Pressure Ulcer (new: hospital)
Physical Restraints
SCIP
Drug Safety
Focused MRSA work

23. Old Work vs. New Work theme by theme (3)
CARE COORDINATION
(note Task 1B Work in Home Health in 8th Scope of Work)
BENEFICIARY PROTECTION
Increasing linkage of case review to quality of care
Increasing awareness of complaint process among beneficiaries
Emphasis on improved efficiency

24. Matching the Scope to the Resources Available
National Implementation
“Subnational” Implementation
Special Projects

25. National vs Subnational
First, consider the “New Work”:
Care Coordination: Subnational
CKD: Subnational
Pressure Ulcer work (in hospitals): National
Focused MRSA Work: National

26. National vs Subnational
Review of “Old Work”:
Cancer Screening & Adult Immunization: National
Focused disparity reduction: Subnational
Patient Safety Work: National
Beneficiary Protection Work: National

27. Special Initiative/Project Funding
Projects essential to:
advance quality improvement and beneficiary protection work with a focus on implementation in the 10th SOW
advance 9th SOW efforts
Management Objectives:
CMS will more aggressively prioritize and manage special projects and results (higher efficiency)
Track and maintain project results / evaluation
Obtain results in time for 10th SOW Implementation (minimum 1 yr in advance)
Link all projects to overall measurement strategy

28. Sample of 9th Scope proposed Special Projects
Use of E.H.R. to improve access and quality of care for minority health
Use of Electronic Prescribing technology to eliminate ADEs, reduce polypharmacy, and increase rate of generic medication prescription
Preventive and chronic care quality improvement initiatives in Medicare Advantage Programs

29. Support for QIOs before and during the 9th Scope of Work

30. “QIOSC-like Entities”: Old ModelPO HH NH U H
QIOs

31. “QIOSC-like Entities”: New Modelf6 f7 f4 f2 f1 f5 f3
QIOs

32. QIOSC-like Entities: Functional Model
F1 = data analytic
F2 = tool development
F3 = training
F4 = communications
F5 = coordination of national networks & campaigns
F6 = evaluation/data on specific interventions
F7 = developing the business case for quality (overlap with F1)

33. Evaluation CONTRACT EVALUATION PROGRAM EVALUATION
ATTRIBUTION OF SUCCESS TO QIO INTERVENTIONS

34. Evaluation “Table of Measures”
Contract Evaluation
“Table of Measures”
Program Evaluation
Independent, Outside Evaluation Contractor
Independent Report on the QIO Program is a final deliverable (2011)

35. “Attribution”
Excellent Measure Set, with continuous, high-quality data
Standardized Interventions, linked to the measures
More CMS control over participant selection
More ability to control for confounding variables

36. SUMMARY 9th Scope of Work now planned
Measurement system (final and interim), Support System structure, List of possible Special Studies
Evaluation Strategy has been worked out in advance, with quantitative targets, some control groups
Higher degree of competition has been introduced (subnational deployment)
Monitoring now has greater transparency, involves both HHS and OMB regularly through contract

37. SUMMARY Interventions are linked to measures
Independent Outside Evaluation contractor will be engaged from the beginning
Final Independent Program Evaluation Report at end of contract
New management strategies will be applied to continuous contract oversight, encouraging high performance throughout the contract period
New contract responsive to all external stakeholders

38. Our Goals are to prevent illness, decrease harm to patients, and reduce waste in healthcare

40. Our Goals are to help providers prevent illness, decrease harm to patients, and reduce waste in healthcare