Quality Improvement Initiatives – Quality Innovation Network (QIN)

5125.2 - Quality Improvement Initiatives – Quality Innovation Network (QIN) - QIO Responsibilities (Rev. 28, Issued: 10-21-16, Effective: 10-21-16, Implementation: 10-21-16) Pursuant to its contract, the QIN-QIO shall: 1. Accept recommendations and referrals from approved sources for technical assistance to practitioners and providers when a need is identified for QIIs based on a confirmed quality of care concern; and 2. Assist provider(s)/practitioner(s) when technical assistance is requested from the practitioner/provider or recommended by other approved sources. Approved sources for referrals and recommendations include: • The Beneficiary and Family-Centered Care- QIOs • The Quality Innovation Network National Coordinating Center (NCC) • Value Incentive and Quality Reporting Center (VIQRC) contractors • Practitioner and/or provider requests for assistance • Others identified by CMS. Upon receiving a referral: 1. The QIN-QIO shall coordinate with the requestor to analyze findings for the referral. 2. For Beneficiary and Family-Centered Care-QIO referrals, the QIN-QIO shall coordinate with the Beneficiary and Family-Centered Care-NCC to analyze findings from the CMS-designated case review system, other information from review activities, and provider performance measures to: • Identify trends and patterns; and • Identify needs for technical assistance related to CMS measures across settings to help providers and/or practitioners meet standards. 3. The QIN QIO shall provide technical assistance that addresses the specific needs the QIO has identified and promotes evidence-based medical practice and beneficiary-centered care principles to improve quality of care and outcomes to beneficiaries. • The QIO shall develop measurable interventions in collaboration with the applicable provider/practitioner practice, taking into account the scope of the provider/practitioner’s practice. The intervention(s) should address systemic confirmed concerns. • The QIO shall assist health care provider(s) and/or practitioner(s), regarding how best to employ successful interventions and proven methods to improve health care quality and lower costs for the Medicare Program. NOTE: If, during the course of a QIN-QIO’s work under its contract (i.e. other tasks in the QIO Task Order), the QIN-QIO identifies problems or concerns that could affect the quality of care that Medicare beneficiaries are receiving, the QIO working with its designated practitioner shall consider the need to request that the practitioner and/or provider initiate and complete an improvement plan to correct the problem. • If an improvement plan is warranted at the time the Quality Innovation Network - QIO requests initiation of the improvement plan, the QIO shall alert its CMS COR in writing of the request and the reason it was warranted; this involvement of the COR is pursuant to the QIO contract. A request for an improvement plan must be data based and clearly state the issue(s) that warrants improvement. The improvement plan must include the goals/objectives to be achieved, the process/measurements/tools to be used to assess the issue(s) and to measure improvement, and the timeframe for accomplishing the improvement plan, including monitoring/documenting improvement. The action to improve the quality of care described in the provider’s/practitioner’s plan must be sustainable. In accordance with its contract, the QIN-QIO shall post tools and resources used in successful interventions on its Quality Innovation Network-QIO website within 30 days of COR/Government Task Lead (GTL) approval.