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Overview. PurposeBackground of Quality Improvement (QI) RequirementsQuality StrategyFuture DirectionsResourcesSummary . PURPOSE. Purpose. Share our current and future vision and directions of the Medicare Advantage (MA) Quality Improvement (QI) ProgramDescribe our new Quality Strategy for th
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1. Medicare Advantage and Prescription Drug and Health Plan Quality Strategy Overview Marsha Davenport, MD MPHCAPT, USPHS
Chief Medical Officer
Medicare Drug and Health Plan Contract Administration Group
April 11, 2012
2. Overview Purpose
Background of Quality Improvement (QI) Requirements
Quality Strategy
Future Directions
Resources
Summary
3. PURPOSE
4. Purpose Share our current and future vision and directions of the Medicare Advantage (MA) Quality Improvement (QI) Program
Describe our new Quality Strategy for the MA and Prescription Drug Plan (PDP) Program
Provide a framework for you to revise and align your QI Program with our new Quality Strategy
5. BACKGROUND: Quality Improvement (QI) Program Overview
6. Background: Medicare Advantage Quality Improvement (QI) Program 42 Code of Federal Regulations (CFR)
§ 422.152
Applies to all MAOs, including SNPs
Development of a Quality Improvement (QI) Program
Seven components of the QI Program
Serves to integrate and coordinate all of the assessment tools and reporting requirements
7. QI Program -2- Chronic care improvement program (CCIP)
Meet the requirements of 42CFR §422.152(c)
Addresses populations identified by CMS based on review of current quality performance
Quality improvement projects (QIPs)
Meet the requirements of 42CFR §422.152(d)
Expected to have a favorable effect on health outcomes and enrollee satisfaction
Address areas identified by CMS
8. QI Program -3- Develop and maintain a health information system
Encourage providers to participate in CMS and Health & Human Services (HHS) QI initiatives
Contract with an approved Medicare CAHPS vendor to conduct the Medicare CAHPS satisfaction survey
9. QI Program -4- Include a program review process for the formal evaluation of the QI Program that addresses at least the following areas on an annual basis:
Impact
Effectiveness
Take remedial action to correct problems identified using ongoing quality improvement
10. Foundations of the MA and PDP Quality Strategy The foundation of our Quality Strategy includes:
42 Code of Federal Regulations (CFR)
§ 422.152
2001 Institute of Medicine Report
Triple AIM
Health and Human Services (HHS) National Strategy for Quality Improvement in Health Care 2011
HHS National Prevention Strategy (NPS) 2011
11. Quality Strategy: Our Goals for MA and PDP We want the Medicare Advantage Organizations (MAOs) and Prescription Drug Plans (PDPs) to compete on quality
We want MAOs and PDPs to provide leadership and innovation in delivering quality health care
Our Quality Strategy is the framework to guide the MA and PDP program
12. Defining Quality