1. CMS QIN-QIO Cardiac Health & Everyone With Diabetes Counts Overview
Good morning. I am Tammy Geltmaker and I serve as the Qsource Quality Program Director for Kentucky.
Qsource is a nonprofit healthcare quality improvement and information technology consultancy, has served as Tennessee’s QIO for more than 40 years, and will now serve as the QIN-QIO for the state of Kentucky.
Qsource provides a range of expert services to assist organizations and providers with improving healthcare quality and delivery with better outcomes and cost savings. Some of those services include . . .
Quality Improvement
Quality Assurance
Program Evaluation
Data Analyses/Data Aggregation
Health Information Technology
Communication and Education
While Qsource has been headquartered in Tennessee since 1973, we have associates placed remotely throughout our service areas, and offices located in Louisville, Indianapolis, Memphis, Nashville, and Knoxville to ensure access and availability to our stakeholders.
CMS QIN-QIO Cardiac Health & Everyone With Diabetes Counts Overview
Don Gettinger
Sharon Barclay

2. Objective
Provide an overview of the goals of the Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network-Quality Improvement Organization (QIN-QIO) 11th Scope of Work (SoW) and Everyone With Diabetes Counts (EDC) initiative including what diabetes educators need to know to become involved in improving outcomes for those with or at risk for diabetes.

3. Restructuring Began exciting new, multi-state 5-year contract:
August 1, July 31, 2019
Beneficiary and Family Centered Care (BFCC)-QIOs
#2 nationwide - Case Review and Monitoring
Quality Innovation Network (QIN)-QIOs
#14 nationwide - Quality Improvement (QI) Activities
From Sue’s AADE PPT
QIOs were established as Peer Review Organizations (PROs) in 1972 under an amendment to the Social Security Act (SSA), Sections 1152 – 1154, with an audit/inspection role
The QIO mission is to improve the effectiveness, efficiency,
economy, and quality of health care services delivered to
Medicare beneficiaries
08/01/14 CMS changed QIO structure so now there are 14 orgs representing all 50 states plus Washington DC, Puerto Rico, and the US Virgin Islands. Work is still performed at a state level, each state just has a larger network of other states with which to closely collaborate and leverage resources.
QINs represent from 2-6 states
From CMS website
A Quality Improvement Organization (QIO) consists of groups of doctors and health care experts to check on and improve the care given to people with Medicare. QIOs work under the direction of the Centers for Medicare & Medicaid Services (CMS) to make health care more patient-centered, safer, and coordinated.
Beneficiary and Family-Centered Care (BFCC) QIOs - Handle beneficiary complaints, quality of care reviews, EMTALA, and other types of case reviews
Quality Innovation Network (QIN) QIOs - Work with health care providers and the community on data-driven projects to improve patient safety, reduce harm and improve clinical care at the local level
Earlier this year, the Centers for Medicare & Medicaid Services (CMS) redesigned its QIO program to further enhance the quality of services for Medicare beneficiaries. Three key QIO changes included . . .
Extending the contract period from 3 years to 5 years
Separating the Beneficiary Case Review activities from the traditional Quality Improvement functions, and having them performed by different contractors.
Effective August 1, 2014, all case review activities for Kentucky, Indiana, Tennessee, Mississippi, and Alabama are now being conducted by KePRO located in Seven Hills, Ohio.

4. atom Alliance
Multi-state alliance for powerful change composed of three nonprofit, healthcare QI consulting companies.
With the restructuring of the QIO program, Qsource is now part of a new multi-state consortia, composed of three healthcare quality improvement organizations. These organizations have joined forces to implement the five-year, five-state Quality Innovation Network (QIN)/Quality Improvement Organization (QIO) contract from the Centers for Medicare & Medicaid Services (CMS).

5. CMS 11th SoW Task Overview
Goals
Improve Cardiac Health
Reduce Disparities in Diabetic Care
Improve Prevention Coordination through Meaningful Use (MU) of Health Information Technology (HIT)
Collaborate with Regional Extension Centers (RECs)
Reduce Healthcare Associated Infections (HAIs)
Improve Mobility and Decrease Healthcare Acquired Conditions in Nursing Homes
Continue and Create Coordination of Care Community Coalitions
Provide assistance in Value-Based Payment, Quality Reporting and the Physician Feedback Reporting Program
HAIs
Central Line Associated Blood Stream Infections (CLABSI)
Catheter Associated Urinary Tract Infections (CAUTI)
Clostridium Difficile (CDI)

6. Cardiac Health

7. Cardiac Health: atom Alliance
Spread Million Hearts initiative
Churches, providers, hospitals, communities, civic groups
Physician Practices - Certified Electronic Health Record Technology (CEHRT)
Report and track:
Aspirin/Antithrombotic with IVD
Controlled blood pressure
Cholesterol LDL-C
Tobacco cessation
Home Health Agencies
Join
Your Church can participate!
100 Congregations for Million Hearts
 If you know of any congregation from any faith-organization that would also be interested in participating, please share this information with them. Feel free to contact us with questions at
Spread Million Hearts initiative Prevent 1 million heart attacks and strokes by 2017
Churches, providers, hospitals, communities and civic groups
Physician Practices - Certified Electronic Health Record Technology (CEHRT)
Report and track:
Controlled Blood Pressure ( <= 130/80)
Tobacco Cessation
Aspirin/Antithrombotic with IVD
Cholesterol LDL-C (< 100)
Home Health Agencies
Report & track via Home Health Cardiovascular Data Registry
Blood Pressure, Aspirin & Cholesterol
The New HHQI CardioLAN
Best Practice Intervention Packages (BPIPs)

8. Patient Education
Key tools and resources
Health literature
Spanish translation version
Many tools or patient resources

9. Patient & Family Engagement
Have patient representatives involved
Empower patients with Medicare to understand their care and be an active participant in their care
Give patients with Medicare the knowledge and confidence to ask important health-related questions and get answers

10. Diabetes

11. Medicare Diabetes Prevalence & Expenditures
60% of Medicare beneficiaries have multiple chronic conditions*
14% of Medicare beneficiaries have 6 or more chronic conditions. Top 5 are: Hypertension, High Cholesterol, Ischemic Heart Disease, Arthritis and Diabetes*
Dual Eligible beneficiaries (those with both Medicare and Medicaid coverage) are 1.4 times more likely to have diabetes*
26.9% of Medicare beneficiaries age 65+ (10.9 million Americans) have diabetes and account for about 32% of Medicare spending**
Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14
*Source: CMS Chronic Conditions Among Medicare Beneficiaries, Chartbook, 2012 Edition **Source: 2013 testimony by the Congressional Diabetes Caucus in the US House of Representatives and the American Diabetes Association)

12. Everyone With Diabetes Counts (EDC) Initiative
Pilot launched in Florida seven years ago
Expanded to nine states/territories (NY, GA, LA, WV, TX, MS, MD, DC, US VI)
Expanded nationally to all QIN-QIOs with 11th SoW
Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

13. EDC Goals Improve health equity by improving health literacy
EDC is a disparity reduction program.
Engage both beneficiaries and health care providers
Improve actual clinical outcomes in the six measures
Facilitate sustainable diabetes education
Improve health equity by improving health literacy and quality of care among Medicare and Dually Eligible beneficiaries with pre-diabetes and diabetes through knowledge empowerment, enabling them to become active participants in their care (patient engagement)
EDC is a disparity reduction program. Target populations are minority underserved and rural (African American, Hispanic/Latino, American Indian/Native American and Asian/Pacific Islander)
Engage both beneficiaries and health care providers to decrease the disparity in diabetes testing by improving testing for HbA1c, Lipids, Eye Exams, Foot Exams and to improve Blood Pressure control and Weight control
Improve actual clinical outcomes of the six above measures
Facilitate sustainable diabetes education resources by engaging public/private agency/organization partnerships at the community, state and national levels
Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

14. EDC Components EDC’s five components:
Recruitment and education of beneficiaries
Recruitment and education of physician practices and staff
Recruitment of partners/stakeholders
Data collection and analysis
Sustainability planning/implementation
EDC is a continuous plan/do/study/act (PDSA) cycle; “keep or tweak”
After spending so much time with partners, beneficiaries, providers, and other stakeholders getting this going, we want to make sure we have a plan on how to keep it going
Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

15. Accomplishing EDC
Recruit, enroll, and teach beneficiaries utilizing a CMS-approved evidence-based DSME program
Provide free DSME classes
6 consecutive weeks
1 class a week
1 ½ to 2 hours each class
Family members or care-givers encouraged to attend
The DEEP DSME curriculum will be implemented in 6 week periods
We plan to express the importance of family and friends because they are the ones who can provide a better support system when they are more knowledgeable about diabetes
Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

16. Accomplishing EDC (Continued)
Increase the number of diabetes educators, certified diabetes educators, community health workers (CHWs), and certified diabetes education sites in Indiana
Recruit physicians
Improve adherence to standards of care for people with diabetes
Improve provider data collection and data analysis skills
Improve use of electronic health records (EHRs)
Educate provider staff
Provide technical assistance to interested practitioners
Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

17. Accomplishing EDC (Continued)
Recruit local and state partners and stakeholders
Mutual disseminate of aligned tools, resources and program information
Collaborate on the train-the-trainer and sustainability plans
Utilize Data
QIN‐QIO will obtain clinical results of diabetes measures for 10% of Medicare beneficiaries who complete DSME
CMS will match the data to Medicare claims data
Allows for following beneficiaries’ data longitudinally over time
Collaborate with subject matter experts who will assist with increasing # of DEs and CD education site.
Local Networking Groups (not Chapters) – For example, TRADE, GLADE, KADE, & DECA
Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

18. DSME Program

19. Diabetes Education and Empowerment Program (DEEP)
University of Illinois at Chicago Midwest Latino Health Research Training and Policy Center
Developed to provide community residents with the tools to better manage their diabetes in order to reduce complications and lead healthier, longer lives. Based on principles of empowerment and adult education
Two Components
Train-the-Trainer
Three day-workshop
Training stresses development of skills and knowledge related to diabetes by using interactive group activities
Diabetes Patient Education
DSME content divided into eight modules
Revised every two years (or as needed) to reflect the most current knowledge and information.
Empowerment is narrowing the gap of understanding between a patient’s goals and how to achieve them.
Empowerment is a process and an outcome
Empowerment allows people to master their situations and make decisions that affect their lives
Education for empowerment is the goal
Education for empowerment must go beyond the acquisition of knowledge

20. DEEP DSME Modules Understanding the Human Body
Exercises to establish trust and solidarity
Systems and organs diabetes affects
Description of what diabetes does to the Organs
What is Diabetes
Diabetes defined
Risk factors
Signs and symptoms of diabetes
Monitoring Your Body
Teach signs, symptoms, and monitoring of hypoglycemia and hyperglycemia and ways to monitor
Teach diabetes management using glucose meter
Get Up and Move: Diabetes and Exercise
Teaching physical activity as a method to control diabetes
Making time for regular physical activity

21. DEEP DSME Modules (Continued)
Nutrition
Basic nutritional concepts
How to read food labels (calories) carbohydrates, salt, and trans fats
MyPlate method and food portions
Exercises on salt and fat hidden in food
Preventing Diabetes Complications
Smoking and circulatory problems
The importance of daily foot care
Reporting abnormalities to providers
Visiting different specialists for prevention and control
Introduction to Medications
Medications for control of diabetes, hypertension and cholesterol
Medications actions, cautions, and side effects
Self-management care guides
Coping with Diabetes
Emotional aspects of diabetes (e.g., stress, depression and patients’ rights)
Involving family and friends in care management

22. DEEP Goals Improve and maintain quality of life
Prevent complications and disabilities
Improve eating habits and maintain adequate nutrition
Increase physical activity
Develop self-care skills
Improve patient and health care team relations
Increase use of available resources

23. DEEP - Methodology & Teaching
Methodology Based
National medical care and self-care education guidelines
Participatory education
Adult education principles
Group work techniques
Progress towards a healthy lifestyle
Role-playing
Teaching Strategies
Brainstorming
Problem-solving
Feed-back
Demonstrations
Modeling
Role-playing

24. DEEP – Target Audiences
DEEP is directed towards:
Persons with diabetes
Their relatives and caregivers
DEEP is written to be implemented by:
Professionals who care for persons with diabetes
Community Health Workers

25. DEEP – Participatory Education
Adults learn best when they are actively engaged and when they learn by doing
Participants learn through discussion and experience
Uses the facilitator concept
Responds to needs of the group
Group involvement for planning and action
Facilitator and students set goals

26. DEEP - Participatory Education (Continued)
Learning:
WE REMEMBER:
of what we read
of what we hear
of what we see
of what we see and hear
of what we do

27. Activity Example
Visual representation of the amount of sugar and fat in a typical diet.
Photo taken by Nancy Semrau, Quality Improvement Advisor

28. DEEP – Flexibility
Modules can be covered in any order in 6 sessions without compromising the program’s integrity
Two trainers for each workshop is recommended but not required
Designed to be adapted to the needs and abilities of the organization and group
Missed sessions can be made up at the discretion of the trainer and participants
Supplies & materials can be made or purchased

29. Becoming a Part of EDC Person with diabetes or pre-diabetes
Attend diabetes education classes when available in the community
Encourage others to attend diabetes education classes
Ask community leaders to volunteer a site for education in the community
Partners and Stakeholders
Contact the QIN-QIO to discuss potential collaborations related to increasing diabetes educators and/or diabetes education sites and cross spreading aligned tools, information and resources

30. Becoming a Part of EDC (Continued)
Providers
Volunteer to become an education site
Refer patients to the free Medicare diabetes education classes
Encourage diabetics and pre-diabetics to attend available classes
Contact us to learn more about free QIN-QIO assistance in becoming a certified diabetes education site for Medicare billing and training appropriate staff to facilitate the DEEP DSME classes

31. Becoming a Part of EDC (Continued)
CDE and Coordinating Body/Local Networking Group Collaborations
Encourage health care providers to take the Certified Diabetes Educator (CDE) exam
Volunteer to be a “CDE Champion” and speak on QIN hosted webinars
Volunteer to be a “CDE Champion” for QIN hosted CDE exam study groups
Collaboration ideas are always welcome!
Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

32. Presentation Acronyms
AADE American Association of Diabetes Educators
ABCS Aspirin, Blood Pressure, Cholesterol, and Smoking
ADA American Diabetes Association
BFCC-QIO Beneficiary and Family-Centered Care-Quality Improvement Organization
CDE Certified Diabetes Educator
CHW Community Health Worker
CMS The Centers for Medicare & Medicaid Services
DEEP Diabetes Education and Empowerment Program
DSME Diabetes Self-Management Education
EDC Everyone With Diabetes Counts
EHR Electronic Health Record

33. Presentation Acronyms (Continued)
HAI Healthcare Associated Infections
HHA Home Health Agency
HHQI Home Health Quality Improvement
HHS Department for Health and Human Services
HIT Health Information Technology
LAN Learning and Action Network
PQRS Physician Quality Reporting System
QI Quality Improvement
QIN-QIO Quality Innovation Network-Quality Improvement Organization
QIO Quality Improvement Organization
REC Regional Extension Center
SoW Scope of Work

34. For More Information Visit new Website for details

35. Indiana atom Alliance Team
Don Gettinger
Quality Data Reporting Manager
Jill Peterson, RN, CRRN
Quality Improvement Advisor
Jean Brizzi, RHIA
HIT Specialist
Sharon Barclay, RN, MSN
Angela Goode
Quality Improvement Advisor
Cathie Pritchard, LPN, RHIT
Deborah Garrison-Downey, MSHE/MBA-SSGA
HIT Specialist
This material was prepared by the atom Alliance, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO), coordinated by Qsource for Tennessee, Kentucky, Indiana, Mississippi and Alabama, under a contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Content presented does not necessarily reflect CMS policy 14.A