Medicare Program; Evaluation Criteria and Standards for Quality Improvement Networks Quality Improvement Program Contracts

ACTION

Notice With Comment Period.

SUMMARY

This notice with comment period describes the general criteria we intend to use to evaluate the effectiveness and efficiency of the Quality Innovation Network (QIN) Quality Improvement Organizations (QIOs) that will enter into contracts with CMS under the Quality Innovation Network Quality Improvement Organizations (Solicitation Number: HHSM-500-2014-RFP-QIN-QIO) Statement of Work (SOW) on August 1, 2014. The evaluation of a QIN-QIO's performance related to their SOW will be based on evaluation criteria specified for the tasks and subtasks set forth inSections C.5, G.22 and G.29 of the QIN-QIO Base Contract and Attachment J-1(b) of the Base Contract; Attachment J-1 is QIN-QIO Task Order No. 001.

 

TABLE OF CONTENTSBack to Top

• DATES:
• ADDRESSES:
• FOR FURTHER INFORMATION CONTACT:
• SUPPLEMENTARY INFORMATION:
• I. Background
• II. Provisions of the Notice With Comment Period
• QIN-QIO Tasks
• Improving Cardiac Health and Reducing Cardiac Healthcare Disparities (See Section B.1 of Attachment J.1, QIN-QIO Task Order No. 001)
• Reducing Disparities in Diabetes Care: Everyone With Diabetes Counts (EDC) (See Section B.2 in Attachment J.1, QIN-QIO Task Order No. 001)
• Improving Prevention Coordination Through Meaningful Use of HIT and Collaborating With Regional Extension Centers (See Section B.4 in Attachment J.1, QIN-QIO Task Order No. 001)
• Reducing Healthcare-Associated Infections in Hospitals (See Section C.1 in Attachment J.1 of the QIN-QIO Task Order)
• Reducing Healthcare-Acquired Conditions in Nursing Homes (See Section C.2 in Attachment J.1, QIN-QIO Task Order No. 001)
• Coordination of Care (See Section C.3 in Attachment J.1,QIN-QIO Task Order No. 001)
• Quality Improvement Through Value-Based Payment, Quality Reporting, and the Physician Feedback Reporting Program (See Section D.1 in Attachment J.1, QIN-QIO Task Order No. 001)
• QIN-QIO-Proposed Projects That Advance Efforts for Better Care at Lower Cost (See Section D.2 in Attachment J.1, QIN-QIO Task Order No. 001)
• Quality Improvement Initiatives (See Section E.1 in Attachment J.1, QIN-QIO Task Order No. 001)
• III. Evaluation of the Tasks
• Annual and 54th Month Evaluation
• Overall Contract Evaluation
• Rounding Rules
• 1. Interim Calculations
• 2. Percentages/Proportions/Rates
• 3. Integers
• III. Collection of Information Requirements
• IV. Response to Comments
• VI. Regulatory Impact Statement

TABLESBack to Top

• Plan & Program Monitoring

DATES:Back to Top

Effective Date: August 1, 2014 to July 31, 2019 for the QIN-QIO contract.

Comment Date: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on September 10, 2014.

ADDRESSES:Back to Top

In commenting, refer to file code CMS-3300-NC. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.

You may submit comments in one of four ways (please choose only one of the ways listed):

1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the “Submit a comment” instructions.

2. By regular mail. You may mail written comments to the following address only:

Centers for Medicare & Medicaid Services,

Department of Health and Human Services,

Attention: CMS-3300-NC,

P.O. Box 8010,

Baltimore, MD 21244-1850.

Please allow sufficient time for mailed comments to be received before the close of the comment period.

3. By express or overnight mail. You may send written comments to the following address only:

Centers for Medicare & Medicaid Services,

Department of Health and Human Services,

Attention: CMS-3300-NC,

Mail Stop C4-26-05,

7500 Security Boulevard,

Baltimore, MD 21244-1850.

4. By hand or courier. Alternatively, you may deliver (by hand or courier) your written comments only to the following addresses:

a. For delivery in Washington, DC—

Centers for Medicare & Medicaid Services,

Department of Health and Human Services,

Room 445-G, Hubert H. Humphrey Building,

200 Independence Avenue SW.,

Washington, DC 20201

(Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without Federal government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)

b. For delivery in Baltimore, MD—

Centers for Medicare & Medicaid Services,

Department of Health and Human Services,

7500 Security Boulevard,

Baltimore, MD 21244-1850.

If you intend to deliver your comments to the Baltimore address, call telephone number (410) 786-9994 in advance to schedule your arrival with one of our staff members. Comments erroneously mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.

FOR FURTHER INFORMATION CONTACT:Back to Top

Alfreda Staton, (410) 786-4194.

https://www.federalregister.gov/articles/2014/08/11/2014-18901/medicare-program-evaluation-criteria-and-standards-for-quality-improvement-networks-quality

Simulations are Powerful Training Tools for your Health Care Organization

Using Simulations for Training Front Line Staff

• Research shows that the level of interactivity within a learning environment is what drives learning.

• The more the learner interacts with the content, the more likely that learning will actually occur.

Engagement Matters

The imperative to create meaningful instruction is stronger than ever, and simulations can drive that engagement!

Each year, the Gallup organization conducts research to measure the level of engagement of employees within organizations.

They use the following terms to describe the state of the employees:

• Actively Disengaged;
• Not Engaged; and
• Engaged

According to a meta-analysis of data compiled by Gallup, the average company has as many as 18% of its employees actively disengaged and 49% of employees not engaged.

Lack of engagement can lead to less productivity, higher accident rates, lower rates of quality, and higher employee turnover.

Reasons to Implement Simulations

• Most effective as an application of learning, rather than as primary learning.

• Help learners bridge the learn-do gap, turning knowledge into action.

• Illustrate the links between individual behavior change and overall organizational success.

Best Practices in Communication

This simulation illustrates how the front line staff can influence overall health outcomes. 

One of the most important jobs in this office is answering the phone. 

The moment you connect with the patient on the other end the care process has begun. 

This course illustrates the power of frontline staff and how their choices affect health outcomes. 

Click on the Picture Above to Launch Simulation

What can mHealth Games do for your Managed Care Organization?

 Kameron Gifford, CPC

Staff Training

Automate and track all frontline training and development initiatives with one easy-to-use solution.

• Reduce your Organization’s ICD-10 Training costs up to 88%.
• Build custom learning plans and automate HIPPA, HITECH and FWA Training.
• Manage multiple certifications, including renewal and expiration processing.
• Audit proof your education programs with the xAPI and prove mastery.
• Build a virtual learning environment (VLE) to launch fun and interactive learning programs.

Clinical Documentation Improvement

Clinical Documentation Improvement or CDI — a process in which care providers receive feedback from specialists who review clinical documents —   delivers clinical and financial benefits for healthcare organizations.  

·       Fill the gaps in care including those found in documentation, coding, quality, and many other aspects involved with the overall care management of a patient.

·       Improve processes, eliminate errors, reduce costs, and increase revenue.

Risk Adjustment Education

·       Identify gaps in coding and documentation that lead to inaccurate risk profiles.

·       Utilize multiple sources of information to transition providers into a prospective system.

·       Provide education and training specific to the needs of each individual practice.

·       Implement and monitor improvement plans to ensure 95% accuracy of claims.

·       Design and initiate compliance plans to ensure protection against state and federal penalties.

·       Analyze, collect and improve HEDIS measurements across every practice.

·       Increase member awareness and understanding of chronic diseases through outreach programs.

·       Documentation and revenue risk assessments proceeding transition into ICD-10.

·       Provide comprehensive ICD-10 transition services that include planning, education, implementation and monitoring

·       Average return on investment is 300+%

  

Patient Generated Health Data (PGHD)

Patient engagement is one of the five goals of the federal government's meaningful use program. PGHD is just one tool in the spectrum of care for patients and caregivers.  PGHD can be a powerful tool in the efforts to achieve the Triple Aim.

·       Work collaboratively with providers, care teams, patients and caregivers to bring PGHD into the care plan.

·       Create tools to improve the patient experience, improve population health and lower health care costs.

·       Utilize innovative methods such as personality assessments to assign members to Primary Care Physicians.

Contact mHealth Games today!

Email  KGifford@mhealthgames.com

RI Medicare Non-Profit Receives $53.4 Million Federal Contract

Healthcentric Advisors, Medicare Rhode Island's Quality Improvement Organization, has been awarded a 5-year, $53.4 million federal contact by the Centers for Medicare and Medicaid Services.

“This award, on the part of CMS, acknowledges the positive role Healthcentric Advisors has played in improving the quality and safety of healthcare in Rhode Island. Again, our state will continue to serve as a national model for healthcare transformation initiatives,” said John Keimig, president and CEO of Healthcentric Advisors.

CMS awarded Quality Innovation Network-Quality Improvement Organization contracts to 14 organizations across the country.  In order to reach the initiatives set forth in the QIN-QIO contract, Healthcentric Advisors will be joined by Qualidigm, the current QIO in the state of Connecticut, as a subcontractor.  Healthcentric Advisors and Qualidigm will administer the contract to all 6 New England states.

"Healthcentric Advisors and Qualidigm will work across New England on strategic initiatives such as reducing healthcare associated infections, reducing readmissions and medication errors, working with nursing homes to improve care for residents, supporting clinical practices in using interoperable health information technology to coordinate care, promoting prevention activities, reducing cardiac disease and diabetes, reducing health care disparities and improving patient and family engagement," a statement from Healthcare Advisors said. "The partnership will also provide technical assistance for improvement in CMS value based purchasing programs, including the physician value-based modifier program."

http://www.golocalprov.com/health/new-ri-medicare-non-profit-receives-53.4-million-federal-contract

Patient satisfaction survey to be rolled out across the entire NHS

A TEST ranking patient satisfaction with the care they have received is to be introduced at all NHS services in Worcestershire and across the country.

The Friends and Family Test – which was introduced at A&E services across England and Wales in April last year – asks patients whether they would recommend the service they received to others should they need healthcare.

NHS England this week said it would expand the test across the whole healthcare sector by April next year.

The test is designed to help patients chose services based on feedback by others while allowing providers to see where they need to improve.

Patients in Worcestershire can take part in the test by completing a card available throughout hospitals.

http://www.eveshamjournal.co.uk/news/11366658.Patient_satisfaction_survey_to_be_rolled_out_across_the_entire_NHS/

Coding, Compliance and Sun Tzu Volume 1 - YouTube

Coding, Compliance and Sun Tzu Volume 1 - YouTube

Dovetail Health Introduces In-Home Pharmacist Program

Dovetail Health Introduces In-Home Pharmacist Program to help Medicare Advantage Plans Improve Star Ratings

NEEDHAM, Mass. -- 

Dovetail Health is pleased to announce its Star Rating Improvement Program that helps Medicare Advantage health and prescription drug plans enhance their star ratings through an in-home pharmacy solution that targets the closure of key gaps in care for health plan members. With increased financial and quality pressures placed on health plans by CMS, strong star ratings are more important than ever before.

Dovetail’s innovative solutions provide critical support to the highest risk members where they need it most- at home. Dovetail integrates seamlessly with its health plan clients, ensuring the highest quality of care and consistent outcomes. This proactive approach focuses on several of the most heavily weighted star measures for prevalent chronic diseases such as diabetes and hypertension along with a primary focus on pharmacy related measures. And, adherence measures are carefully monitored over time.

Star Rating Improvement Program

Dovetail’s clinical model for its Star Rating Improvement Program involves sending highly trained pharmacists into members’ homes to conduct Comprehensive Medication Reviews, (“CMR”), and generate reports that help members to be compliant with essential quality metrics. Dovetail’s report meets CMS guidelines to ensure that plans receive credit for the CMR’s that Dovetail completes.

The pharmacist provides a written report and telephonic follow up with prescribing physicians to discuss any recommendations for a member’s prescriptions. This information is invaluable to physicians, enabling them to better understand specific factors such as social and financial issues that are impacting their patients at home. Following the initial home visit, the pharmacist will call members to ensure recommendations are followed and any new prescriptions are filled. Dovetail Pharmacists provide more acute members with telephonic and in-home consultations as needed.

To operate efficiently and consistently, Dovetail utilizes a proprietary health management software system exclusively designed to assess members’ gaps in care while managing every facet of program delivery. Furthermore, Dovetail provides plans with data from its system to ensure they receive proper credit for the star measures addressed by Dovetail.

According to Stever Aubrey, CEO of Dovetail Health, "We give our pharmacists the training and tools they need to deliver effective and consistent results with every member they see, and we ensure that the information we collect is shared with all the key stakeholders.”

Dovetail’s pharmacists coordinate closely with members’ physicians and other caregivers which is critical to the success of the program. Diane Gilworth, NP, Chief Clinical Officer at Dovetail Health adds, "At Dovetail, our pharmacists provide valuable, actionable information to physicians in order to optimize medication regimens, close gaps in care, and ultimately improve Star Ratings.“

Dovetail Health is a leading provider of healthcare solutions, focused on improving quality of care and reducing cost to high risk patients in the place where they need it most - in their own homes. Combining trusted in-home pharmacists with proprietary technology systems, Dovetail delivers significant clinical and financial outcomes for its health plan, provider group, ACO, and hospital partners. For more information, visit www.dovetailhealth.com.