Quality Improvement Organizations improved care coordination, avoided readmissions in 2016, CMS says

QIN-QIOs and BFCC-QIOs reported savings and improved care related to their 2016 activities.

The Centers for Medicare & Medicaid Services reported results and milestones for its Quality Improvement Organization (QIO) program in 2016.

The programs, which encompass Quality Innovation Network QIOs (QIN-QIOs) and Beneficiary and Family Centered Care-QIOs (BFCC-QIOs), aim to drive higher quality, more efficient and more equitably distributed healthcare.

The report highlighted improvements in care coordination, which the agency estimated avoided more than 24,000 unnecessary readmissions affecting over 23 million beneficiaries. CMS also reported healthy expansion of diabetes self-management education programs, which QIN-QIOs helped to provide to more than 27,000 beneficiaries in rural, poor and diverse communities.

BFCC-QIOs reported $20 million in cost savings through its reviews of concerns regarding quality of care and the implementation of quality improvement initiatives. In 2016, BFCC-QIOs targeted the failure to establish an appropriate treatment plan as their primary concern and conducted reviews of discharge appeals that led to improved care for more than 68,000 beneficiaries.

The QIO program also reached a number of key milestones in 2016:

  • CMS awarded $347 million in Hospital Improvement Innovation Network contract awards, supporting efforts to reduce hospital-acquired conditions and readmissions in Medicare
  • CMS awarded 20 Special Innovation Projects to 12 QIN-QIOs in October. These two-year commitments target healthcare issues that could generate a significant impact if successfully scaled on a local, regional or national basis
  • In June 2016, the organization launched an initiative through the QIO Program’s Strategic Innovation Engine to engage industry stakeholders including insurance companies, providers and professional associations to design and implement innovative practices based on experiences in their own communities. Once approved, CMS expects to consolidate the information into Quality Improvement Innovation Packages which it hopes will spur broad implementation of the practices.