Presentation - Right Care Initiative

Medicare Quality Improvement and
Provider Technical Assistance:
An Overview of the Next Five Years
December 8, 2014
Mary Fermazin, MD, MPA, Chief Medical Officer
Health Services Advisory Group
Presentation Outline
• A review of QIN-QIO’s scope of work in general,
with special emphasis on the work with physician
• Technical Assistance to Providers
– Million Hearts campaign
– Chronic care management of diabetes care
• Patient Community Meetings
– Diabetes Self Management Education
– Check.Change.Control
QIN-QIO Framework
QIN- QIO : Results Oriented Quality
• Serve as neutral convener and actively engage
providers, partners and patients
• Utilize data as core component of QI efforts,
provide regular data feedback reports
• Use Learning and Action Networks to facilitate rapid
learning, disseminate best practices that lead to
system changes and sustainable results
• Provide focused technical assistance and coaching
Chronic Care Model
Cardiac Health
Conditions in
Nursing Homes
Disparities in
Patient is at the center of care.
Coordination of
Infections in
Chronic Disease
Meaningful Use
Improve Cardiac Health and
Reduce Disparities
• Implement evidence-based practices to improve
cardiovascular health
• Support Million Hearts® initiative
• Promote the use of Aspirin, Blood pressure control,
Cholesterol management, and Smoking assessment
and cessation (ABCS)
– Work with racial and ethnic minority beneficiaries/dualeligibles, and providers to improve ABCS
Technical Assistance
• Million Hearts
– Physician Quality Reporting System using EHR
– EHR reports on patients with hypertension
– Workflow analysis and redesign for managing patient
– Controlling High BP; Tobacco Use: Screening and
Cessation; IVD: Use of Aspirin or Another Antithrombotic;
and Fasting LDL-C Test Performed and Stratified
Technical Assistance
• TA focus: those providers who manage patients with
the greatest cardiovascular health needs and those
most challenged to succeed in implementing
evidence-based practices to improve cardiovascular
health and support the Million Hearts® initiative.
• Eligible Providers
– Current measures below Million Hearts goal of 65%
– Target providers who serve racial and ethnic minority
Medicare beneficiaries, dual-eligible Medicaid and
Medicare beneficiaries
Reduce Disparities in Diabetes Care:
Everyone with Diabetes Counts
• Improve HbA1c, lipids, blood
pressure, and weight control
– Combination of provider-based
and community-based strategies
• Decrease number of
beneficiaries requiring lowerextremity amputations
– Claims data evaluation and
aggregation of data for the state
and the QIN-QIO area
Reduce Disparities in Diabetes Care:
Self Management Education Training Classes
• Use train-the-trainer program to increase the
number of certified diabetes educators and
community health workers
• Refer diabetic patients from recruited medical
• Use community-based approach to encourage
program spread
Reduce Disparities in Diabetes Care: Increase
Adherence of Utilization Measures
• Includes HbA1c, lipids, eye
and foot exams
– Provider engagement
– Clinical data input and
reporting through EHR
– Reporting on eye exams and
foot exams
Technical Assistance
• Chronic care management of diabetes care
– EHR reports on patients with hypertension
– Workflow analysis and redesign for managing patient
– Increasing adherence to clinical guidelines for
appropriate use of utilization measures for HbA1c, Lipids,
and Eye Exams
– Decrease lower extremity amputations
– Refer patients with diabetes to DSME
Technical Assistance
TA Focus:
• At least 25% of a Participating Practitioner
Clinics/Offices/Practices Medicare diabetes patient
population are a racial or ethnic minority/rural/ or in
an underserved area
• Based on analysis of Medicare claims, each
Participating Practitioner Clinic/Office/Practice with
claims results ranked in the lower 50th percentile
among all practices in the QIN-QIO area for at least
two of the three utilization measures: HbA1c, Lipids,
and Eye Exam. (FQHCs and RHCs are exempt)
Quality Improvement through Value-Based
Payment Programs
• Increase number of eligible physicians and physician groups
submitting data through Physician Quality Reporting System
• Demonstrate improvement in quality of care delivered by
physician groups and hospital outpatient departments
• Increase national performance levels on hospital VBP
• Increase percentage of ambulatory surgery centers and
inpatient psychiatric facilities that improve quality on poorly
performing quality measures
Patient Community Meetings
• Engage patients and families in the community through
meetings where they congregate:
– Senior centers
– Faith-based organizations
– Libraries
• Engage partners in patient community meetings, such
as providers, the American Heart Association, clinical
pharmacists, etc. to educate patients on:
Self management of chronic disease
Patient portals
Medication safety
Availability of community health resources
Mary [email protected]
Chad [email protected]
Kim Salamone [email protected]
This material was prepared by Health Services Advisory Group, Inc., the Medicare
Quality Improvement Organization for California, 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.
Publication No.CA-11SOW-B.1-09242014-02

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