Health Care Excel

In August 2011, the Centers for Medicare & Medicaid Services (CMS) marked a bold, new direction in improving health care services for Medicare beneficiaries. Between now and July 2014, CMS is launching a series of projects led by the Quality Improvement Organization (QIO) Program. Health Care Excel, the Medicare QIO for Indiana and Kentucky, is focusing on three aims for Hoosier seniors: better individual patient care, better population health, and lower health care costs by improvement through the following efforts.

• Fulfilling CMS’ obligation to protect the rights of Medicare beneficiaries by reviewing quality of care concerns and appeals and denial or discontinuation of health care services. The QIO advocates for beneficiaries and their families to be meaningfully involved in QIO improvement and prevention activities.
• Working with hospitals to achieve as much as 50% reductions in health care-associated infections (HAI) that will contribute to as much as a 50% reduction in national HAI rates. The initiative will reduce central line-associated blood stream and catheter-associated urinary tract infections by implementing the Comprehensive Unit-Based Safety Program (CUSP), Clostridium difficile, and surgical site infections.
•  Contributing to a 40% national reduction in health care-acquired conditions (HAC), such as catheter-associated urinary tract infections (CAUTI) and falls. The QIO also is working with nursing homes to improve pressure ulcer prevention and reduce physical restraint use.
• Improving the quality of care for high-risk Medicare patients by working with clinical pharmacists, primary care clinics, and other providers that care for older patients with multiple chronic conditions to reduce adverse drug events (ADEs). The initiative focuses on increasing patient self-management skills, reducing unnecessary hospital readmissions, and forming community relationships to ensure community-wide adoption of improved practices.
• Assisting physician practices that want to use their electronic health record system to coordinate preventive services like flu and pneumococcal immunizations, and colorectal and breast cancer screenings. The QIO is partnering with local Health Information Technology Regional Extension Centers (REC) to promote health information technology integration into clinical practice.  
• Collaborating with hospitals, nursing homes, home health agencies, dialysis facilities, physician practices, patient advocacy organizations, and other stakeholders to reduce hospital readmissions. The QIO will assist in the goal of reducing hospital readmissions within 30 days of discharge by 20% over three years by changing processes of care at the community level.

New Ways to Work Together

New models for accelerating and spreading change have shaped Health Care Excel’s approach to working with health care providers and partners. Providers and partners have more and different ways to be a part of QIO initiatives. Health Care Excel is convening a statewide Learning and Action Network (LAN) that recognize everyone’s knowledge and contribution to better health care. Through an “all teach all learn” large-scale LAN approach, the QIO will accelerate the pace of change and rapidly spread best practices. Improvement initiatives include collaborative projects, online interaction, and peer-to-peer education.

By participating in the LAN, health care providers and partners can join a community for addressing common challenges, connect with a peer facility for mentoring, and be the first to know about improvement breakthroughs—and how to replicate them in their own facility or practice.

Beginning in 2013, Health Care Excel will launch a statewide LAN for nursing homes that will address catheter-associated urinary tract infections, falls, and other HACs. Learning and Action Network participants can learn from local and national peers, obtain evidence-based tools and resources, and participate in an improvement collaborative. Focusing on ADEs, providers and partners can expect to benefit from participation in a statewide LAN by accessing evidence-based tools for assessing pharmacy processes and implementing safer practices, support for rapid-cycle improvement, and strategies for spreading success within their community.  Physician practices also can participate in a LAN focused on reducing patient risk factors for cardiac disease.

Learn More and Become Involved

The QIO Program invites all health care providers, Medicare beneficiaries, family members, caregivers, and other health quality stakeholders and partners to be part of these new improvement initiatives. More information about the QIO Program is available online at http://www.hce.org/medicare.

To attend Health Care Excel’s November 9, 2011, LAN meeting in Indiana at the Indianapolis Marriott East, go to Health Care Excel’s LAN meeting, or contact Amy Tooley, Administrative Assistant, at atooley@inqio.sdps.org, or call 812-234-1499, extension 269.

To attend Health Care Excel of Kentucky’s November 3, 2011, LAN meeting at the Hilton Garden Inn Louisville Airport, go to Health Care Excel’s LAN meeting, or contact Scott Gibson, Community Resource Advocate, at sgibson@kyqio.sdps.org, or call 502-454-5112, extension 2231.

Become a Physician Reviewer

For information on how to become a physician reviewer for Health Care Excel’s Beneficiary and Family Centered Care initiative, go to How to Become a Physician Reviewer, or contact Cheryl Riddell, RN, Program Manager, at criddell@inqio.sdps.org, or call 812-234-1499, extension 237.

The QIO Program is an integral part of the U.S. Department of Health and Human Services’ National Quality Strategy to transform America’s health care system. The CMS administers the program through a national network of 53 independent QIO contractors located in each of the 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands.  It serves as the largest federal program dedicated specifically to improving health care quality at the community level.

This material was prepared by Health Care Excel, the Medicare Quality Improvement Organization for Indiana and Kentucky, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Contents presented do not necessarily reflect CMS policy. 0SOW-HCE-GENE-11-006  9/28/11