HealthInsight has been named to lead health care quality improvement activities for the Medicare Program for a four-state region serving Nevada, New Mexico, Oregon and Utah under a five-year contract awarded by the Centers for Medicare & Medicaid Services (CMS).
On July 18, 2014, HealthInsight became the Quality Innovation Network-QIO (QIN-QIO) for the four states for a contract term extending through July 2019. In its most recent Request for Proposals to perform this work, CMS required that each bidder's proposal cover at least three states and a maximum of six states, rather than a single state as in the past.
HealthInsight has served as the Medicare Quality Improvement Organization (QIO) continuously for Utah since 1984 and in Nevada since 1988. The New Mexico Medical Review Association continuously held the Medicare QIO contract for its state since 1984 and affiliated with HealthInsight in 2012. Acumentra Health has also conducted Oregon's Medicare QIO activity since 1984 and will join as a subcontractor working along with the three HealthInsight states under the new QIN structure.
As the QIN-QIO, HealthInsight will work with local health care providers in each of the four states to promote patient-centered care, make care safer and more affordable, and improve population health. The company will engage hospitals, nursing facilities, physician practices, home health agencies, Medicare beneficiaries and families and related key stakeholders throughout the state to develop and apply proven strategies for delivering safer, more efficient care.
"We look forward to the opportunity to continue to support the Medicare quality initiatives in our region," said Marc Bennett, president and CEO of HealthInsight. "Each of our states bring a wealth of knowledge, experience and commitment to ensuring patients receive the right care, at the right time, every time. Working together as a QIN provides the opportunity to share resources and expertise to best serve the needs of Medicare beneficiaries and health care providers in our region."
The major strategic aims of the upcoming five-year work program for CMS include the following:
Healthy People, Healthy Communities: Promote effective prevention and treatment of chronic disease, a major driver of Medicare costs, by:
- Improving cardiac population health and reducing disparities in care for heart attack and stroke
- Reducing disparities in diabetes care by improving self-management skills among members of targeted beneficiary populations
- Helping providers use electronic health record (EHR) technology to improve the coordination of preventive care, such as immunizations and screening
Better Health Care for Communities: Make care safer by reducing harm caused in the delivery of care and promote effective coordination of care, including:
- Reducing healthcare-associated infections in hospitals
- Reducing healthcare-acquired conditions such as pressure ulcers and the consequences of patient falls in nursing homes
- Improving coordination of care for Medicare patients across health care settings, with emphasis on reducing hospital admissions and readmission rates and preventing adverse drug events, a leading cause of preventable patient harm
Better Care at Lower Cost: This aim dovetails with the CMS program to encourage quality improvement through value-based payment of providers, quality data reporting, and the Physician Feedback Program. HealthInsight will support hospitals, physician practices and other providers in reporting quality data electronically and in developing the capacity to use their own data to improve care processes.
Success in many of these tasks will depend on engaging Medicare beneficiaries and their family members and representatives as active partners in the beneficiary's health and plan of care.
Due to changes made by CMS in Medicare Program rules, HealthInsight and Acumentra Health will no longer be performing medical case review to investigate Medicare beneficiaries' concerns about the quality of their medical care and about the duration of skilled health care services they receive. CMS has assigned that task to two new Beneficiary and Family-Centered Care QIO contractors: KEPRO and Livanta. Effective August 1, 2014, Medicare beneficiaries who have concerns about the quality of medical care they receive from New Mexico or Utah providers should call KEPRO toll-free at 1-844-430-9504; and in Nevada and Oregon beneficiaries should call Livanta toll-free at 1-877-588-1123.