Embracing Challenges and Accommodating Risk as a Driver of Transformation in the QIO Program

Change is in the air. Even as we formally launched our new company earlier this month, our Comagine Health team was hard at work on a fundamental reimagining of the work we do for the Centers for Medicare & Medicaid Services (CMS).

Through our predecessor organizations Qualis Health and HealthInsight, we have a decades-long history of helping CMS achieve its goals of improving the quality and efficiency of the U.S. health care system. Through CMS contracting, we’ve collaborated with our community partners over many years as Quality Improvement Organizations, End-Stage Renal Disease Networks, and Hospital Improvement and Innovation Networks. These CMS-funded programs have helped us continue our work in communities across our regions to solve the most challenging problems in health care.

Now, in 2019, CMS is implementing significant changes in how they pursue their quality goals. Earlier this year, they announced awards to Comagine Health and 58 other organizations as the Network of Quality Improvement and Innovation Contractors (NQIIC), who will now be able to compete for contracts that will drive quality improvement efforts across settings.

Right now, we are building a proposal for the first NQIIC task order, the 2019-2024 iteration of the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) program. We are preparing to implement programs that will tackle some of our toughest challenges:

• Improving behavioral health outcomes, focusing on decreased opioid misuse
• Increasing patient safety
• Increasing chronic disease self-management
• Increasing quality of care transitions
• Improving long-term care quality

And CMS has built in significant changes — challenging us and other contractors to commit to these ambitious goals while also taking on financial risk for those results. In short, CMS is asking us to embrace value-based purchasing in quality improvement, akin to the reimbursement changes and challenges faced by health care providers and delivery systems across the nation. We believe CMS should continue to innovate to obtain the best value for taxpayers. This new approach embraces the belief that “aims define systems” — our new outcome goals begin with bold aims that compel us to stretch substantially, requiring us to do things that we don’t yet know how to do. We stand ready to support this vision.

These new contracts require demonstrated achievement of improvement targets, with a substantial portion of our funding (at least 40%) at risk in a price-competitive environment. Success will only be possible to the extent we are able to engage our communities to effectively achieve significant measurable improvement. Together, we will start with the aims, and then design (and redesign), build (and rebuild) and iteratively adapt the systems we will use to deliver on those aims. We invite all of you, our partners, to join us in this vision and this commitment so that all in our communities can flourish.

This will be hard, but it isn’t impossible if we hold fast to our vision and our passionate commitment to partnership with all of you — with patients and families, with providers and payers across our regions, and with other community stakeholders. We can do it, together!