CMS Quality Strategy and Organization - 2004

1. CMS Quality Strategy and Organization - 2004 Sean Tunis - CMS QIO Leadership retreat July 23, 2004

2. Changing landscape for quality New faces Mark McClellan, Clay Ackerly Terry Kay Trent Haywood, Lisa Hines Gary Baily, Sharad Mansukani Reorganizations QMHAG returns to OCSQ QIG reorg Working on better ISG/QIG alignment Exploring optimal OCSQ/quality management Quality coordination office (?) RO issues Quality Council restored MMA Governance council and OS

4. CMS Quality Council Participants and roles Workgroups Clinical priorities Health Information Technology Technology and Innovation MQIC (?)

5. Clinical Priorities Workgroup Systematic process for identification Potential clinical/$$ impact, existing partnership, promotes IT, MMA priority, measures, etc. Deploy all appropriate Agency tools Tentative topics Vascular access Pressure ulcers and restraints Adult immunization Surgical complications Site infections, PE, MI, vent-associated pneumonia Workforce Decreased turnover of RN and NA in hosp and nursing homes

6. Technology and Innovation Effective Innovation MMA Sec 942(b): CTI Guidance documents Stakeholder engagement Coordination with FDA Improving Evidence MMA Sec 1013 NIH-CMS collaborations Research methods development

7. Health Information Technology Extensive involvement with ONCHIT EHR Private sector initiative for system standards and certification had first meeting: EHR certification 1 yr Alliance on financial incentives for HIT All major payers and purchasers Exploring malpractice premium reduction with HIT use DHHS discussions of Sec 649 and 8th SOW (focus on QIOs / HIT) E-prescribing standards and required option by PDPs Stark / anti-kickback proposal under discussion PHR � CBC pilot of web-based portal for benes (claims) CPOE and bar-coding: exploring options with experts

8. NHII meeting July 21, 2003 Few specifics but clear federal commitment to EHR Announced pubic and private purchaser alliance on financial incentives for HIT Will affect receptivity in all states �ONCHIT will encourage private sector organizations to evaluate potential vehicles to provide support on a cost-effective and trusted basis�

9. Small group discussion Identify something about your QIO or the QIO program that CMS central or regional offices appear not to know or understand.

10. Three Phases of the QIO Program Case Review: PSROs and PROs relying primarily on case finding, from the First through the Fourth Scopes of Work Quality Improvement: local then national QI, ultimately largely around publicly reported measures, in the Fifth, Sixth, and Seventh Scopes of Work Transformational Change: Eighth SOW and beyond

11. Transformational Change We are no longer in the business of helping the system do it better, we are in the business of helping the system do it right. Doing it right requires transformation of the healthcare system. ? We must focus on projects where our efforts are likely to be transformational.

12. Accelerating Change Create partnerships with others involved in improving health care Promote the use of comparative performance data, transparency, and public reporting Promote the use of information technology to increase efficiency and accuracy Spread learning and success Focus on increasing system reliability and safety Promote the use of rapid cycle improvement and process redesign methods Focus on decreasing waste and inefficiency Support and promote workforce development

13. Some transformational projects Office information technology reimagines how doctors� office work is done Surgical care improvement partnership imagines an army of stakeholders working effectively together Mediation reimagines what to do with a complaint Corporate partnerships (nursing homes and dialysis) reimagines government-business relationships

14. Is Our Aim Too High?Many Would Say Yes Providers are preoccupied with survival, and don�t have the resources or motivation to commit to transformational change QIOs don�t have the resources to provide the type of assistance needed QIOs don�t have the knowledge base or skills to provide the type of assistance needed Performance-based contracting will result in QIO failure if transformational change is expected The program does not provide adequate support to enable QIOs and CMS staff to be effective and efficient

15. How Can We Be Successful in Aiming High?Strategic Planning Process Clarified mission, vision, and goals Identified strategies and applied them to our key processes With external customers�the core work that QIOs are contracted for With internal customers�processes that impact QIOs and CMS staff

16. Leverage and transformation Regional office collaborations Role in quality-related demos (eg 721) Increased QIO �centers of excellence� with regional or national scope

17. Sec 649: MCMP Extension of DOQ-IT project with PFP Currently under review by gov council Secty shall contract with �QIOs or such other entities� to carry out the program 2 key issues, with deep roots QIOs vs other entities Model for transmission and storage of data

18. Sec 649: QIO vs other QIOs have expertise and relationships with providers QIOs can receive multipayer data and protect from discovery QIOs have improvement and regulatory functions Opening to non-QIOs allows for greater competition and perhaps greater expertise

19. Sec 649: data Current proposal has patient level data from demo collected in QIO data warehouse May be critical to improvement / eval Potential privacy / confidentiality concerns Alternatives are to collect de-identified data or use regional health info data exchanges

20. Sec 649 and 8th SOW Common potential challenges Promote EHR through financial incentives and allow market to handle diffusion Single common site for person level data makes some folks very uncomfortable Concerns about performance of QIOs compared to other contractors, and adequacy of performance metrics