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What is Return on Investment for the QIO Program?


Thoughts from a fiscally conservative taxpayer

I have been working for HealthInsight since 1995 and most of that time has been spent operationalizing the Medicare Quality Improvement Organization (QIO) contracts over the years. During this journey, there have been numerous times when the QIO program has been assessed by various entities to determine whether it produces value for Medicare beneficiaries, health care providers and ultimately the U.S. taxpayer who funds the program.

In the effort of being transparent, I believe any taxpayer funded program should be thoroughly reviewed to determine value to the ultimate funder. After all, the U.S. has a national debt approaching $20 trillion or about $60,000 per citizen, so all dollars need to be cherished. If the QIO program is funded in the $1 - $3 billion range—an educated guess—for this contract cycle, what is the estimated return on that investment? What impact, if any, does the QIO program have in driving change?

Being part of the QIO program for over two decades, I have sometimes struggled with my own internal debates and have been defensive when it appears the QIO program has received criticism from various entities for failing to "transform" the health care system or failing to be a cost effective program. I argue of course the QIO program is producing change and transformation. I pull out pre and post measures and data over time to show localized impact as well as community engagement levels. On the other hand, I ponder: is the QIO really a primary lever in any observed changes? Would any of these observed and measured improvements have happened without the QIO program?

Although I am slightly—OK, more than slightly—biased, I have come to the conclusion that YES indeed, the QIO program is a wise investment. I have observed dramatic changes both locally and nationally in the areas of health information technology adoption, quality improvement in nursing homes, hospitals and physician offices across a wide array of quality measures. While providers ultimately deserve credit for these improvements, I cannot help but believe the QIO program has been and continues to be an effective catalyst for change.

To build upon my viewpoint, the Centers for Medicare & Medicaid Services (CMS) recently released the 2016 QIO Program Progress Report. The report highlights how Quality Innovation Network (QIN)-QIOs nationwide are bringing together local providers, partners and other stakeholders to achieve bold goals in health care quality improvement. It includes successes from the third year of the Program's five-year performance period, data-driven results from QIN-QIOs and Beneficiary and Family-Centered Care (BFCC)-QIOs. Dennis Wagner, director of the Quality Improvement and Innovation Group (QIIG) within CMS' Center for Clinical Standards and Quality said, "2016 was an outstanding year for both QIN-QIOs and BFCC-QIOs. QIN-QIOs were especially successful in achieving impactful results in the areas of care coordination, diabetes care and nursing home care. QIN-QIOs' work contributed to more than 24,300 hospital readmissions avoided, more than 27,800 beneficiaries educated in diabetes self-management, and a 21 percent reduction in inappropriate antipsychotic medication usage at nursing homes throughout the United States. Together, QIN-QIOs and BFCC-QIOs helped improve the effectiveness, efficiency and quality of care provided to our nation's Medicare beneficiaries."

Although there will never be "proof" that the QIO program is the change driver, I believe the 2016 Progress Report along with our HealthInsight observations over three decades lend strong evidence that health care is transforming and the QIO program is a valuable tool in that transformational process.

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