CMS QIO
Stratis Health has served as Minnesota’s Quality Improvement Organization
(QIO) under contract with the Centers for Medicare & Medicaid Services (CMS)
since the program’s inception in the 1970s. Today, QIOs work to improve patient safety and the quality of care delivered to Medicare beneficiaries. The current three-year
contract covers 2008 to 2011.
We are uniquely positioned to effectively and efficiently meet the goals of the Medicare QIO Program in Minnesota. We are well integrated with the Minnesota health care community, have a great depth of knowledge and expertise in improving quality and patient safety, have a strong record of performance for all of our contracts and grants, and have continuously held the QIO contract in Minnesota since the inception of the program.
Success 2005 - 2008
- 96% stakeholder satisfaction for our QIO work—ranking first in the nation for overall satisfaction, according to a 2007 CMS survey
Stratis Health staff of approximately 60 professionals possesses strong applied research and clinical experience and expertise in continuous quality improvement theory and implementation, biostatistics, data analysis, data management, medical record abstraction, coding, health education, project management, health informatics, and communications.
Protecting Medicare consumers and the Medicare Trust Fund
Stratis Health has over 35 years experience in conducting medical case review—determining whether services provided were reasonable and medically necessary, were
provided in the most appropriate setting, met professionally recognized standards of
health care, and were appropriately billed.
The learnings from case review are used to
develop quality improvements focused on
system-wide changes, bolstering the Minnesota
health care community’s approach to reducing
medical errors, which emphasizes a culture
of learning, justice, and accountability. Stratis
Health leverages this philosophy to further the
systems and process improvement work that
arises from all aspects of the beneficiary protection program.
Medicare rights and responsibilities
protections
Stratis Health supports Medicare consumers in Minnesota by maintaining a helpline—providing callers with information concerning Medicare rights and responsibilities,
protections, and various QIO programs and initiatives. Stratis Health coordinates
alternative dispute resolution on behalf of Medicare consumers and their providers, and
third party mediators when needed.
Success 2005 - 2008
- Responded to more than 5,000 Medicare medical record review cases, including beneficiary complaints, coverage and discharge appeals, hospital admissions appeals, and quality of care concerns
Stratis Health supported Medicare consumers in Minnesota by maintaining a helpline—providing callers with information concerning Medicare rights and responsibilities, protections, and various QIO programs and initiatives.
Transparency in quality and patient safety
Medicare is committed to making information about health care performance available
and giving consumers additional tools for decision-making. Stratis Health supports this transparency in quality and patient safety by working with all Minnesota hospitals to
collect and submit quality data, identifying areas for improvement, and offering them educational and technical assistance on the use of CMS systems and reporting tools.
Success 2005 - 2008
- Responded to more than 5,000 Medicare medical record review cases, including beneficiary complaints, coverage and discharge appeals, hospital admissions appeals, and quality of care concerns
Stratis Health supported Medicare consumers in Minnesota by maintaining a helpline—providing callers with information concerning Medicare rights and responsibilities, protections, and various QIO programs and initiatives.
- Fielded 4,900 help-line calls and performed 2,200 expedited appeals
- Over 90% of beneficiaries were satisfied with our complaint review process
Medicare is committed to making information about health care performance available and giving consumers additional tools for decision-making. Stratis Health supported
Stratis Health worked with hospitals across the state to reduce the incidence of improper fee-for-service inpatient acute care Medicare payments. We conducted data analysis and focused audits, and recommended system changes and improvement strategies.
- 21.5 to 55.8% reduction in billing errors
- Providers fine tuned clinical decision making, reduced payment problems, and lowered their compliance risk; which saved Medicare $1.5 million a year
Improving care for Minnesotans 2008 - 2011
The following beneficiary protection activities are included in our current QIO contract:
- Using case review data to link individual quality of care issues to system-based quality improvement activities, then working with providers to implement improvements
- Helping Medicare consumers understand their rights, responsibilities, and protections, in addition to effectively managing the complaint process
- Assisting hospitals with reporting quality data
- Publishing measures of hospital performance, including clinical quality and patient experiences of care, on www.mnhospitalquality.org
Improving patient safety
Evidence shows that harm to patients can be reduced by enhancing certain health care processes and systems. To improve patient safety under the CMS National Patient Safety Initiative, Stratis Health provides training, clinical improvement technical assistance, organization leadership assessment, and support for culture change toward person-centered care.
This work builds on Stratis Health’s previous work in the areas of surgical care, heart failure, pressure ulcers and restraints in nursing homes, and drug safety; as well as applies our knowledge to the new areas of methicillin-resistant Staphylococcus aureus (MRSA), pressure ulcer prevention in hospitals, and technical assistance for select nursing homes.
Aligning with the priorities of the Minnesota Alliance for Patient Safety and Minnesota’s Adverse Health Event Reporting Law, Stratis Health’s QIO improvement efforts advance patient safety in Minnesota.
Improving care for Minnesotans 2008 - 2011
The following patient safety activities are included in our current QIO contract:
- Reducing MRSA infection rates
- Reducing rates of pressure ulcers in nursing homes and hospitals
- Reducing rates of use of physical restraints in nursing homes
- Improving inpatient surgical safety and heart failure treatment in hospitals
- Improving drug safety
- Providing quality improvement technical assistance to select nursing homes
Promoting prevention
The goal of our CMS prevention work is to improve the quality and frequency of preventive health care services through improved use of technology. Stratis Health will assist adult primary care clinics in utilizing the preventive services and care management capabilities of their electronic health records (EHRs) to provide evidence-based practice that will improve rates of mammography and colorectal cancer screenings, and of influenza and pneumoccocal immunizations for Medicare consumers.
To accomplish this work, Stratis Health is partnering with a select group of clinics to optimize care management processes, using the provider’s certified EHR to facilitate notification of providers and patients when screenings and immunizations should be scheduled and tracking when they have been completed.
Improving care for Minnesotans 2008 - 2011
The following prevention activities are included in our current QIO contract:
- Increasing rates of mammography
- Increasing rates of colorectal cancer screening
- Increasing rates of influenza immunizations
- Increasing rates of pneumoccocal immunizations
Additional success in improving health care as the QIO from 2005 - 2008
From November 2005 to July of 2008, Stratis Health had great success working with health care providers across the settings of care in Minnesota—hospitals, clinics, nursing homes, and home health agencies—helping them achieve excellence in care delivery. Also, we worked to protect Medicare consumers and the Medicare Trust Fund. By accelerating and broadening the impact of quality improvement, our work lead to measurable improvements in care for Minnesota’s 700,000 Medicare consumers.
Assisted health care providers in achieving excellence in care
Stratis Health worked with Minnesota’s nursing homes, home health agencies, hospitals and physician offices to improve clinical quality and safety, as assessed by more than 40 measures. We assisted them in redesigning care processes and transforming organizational culture; and in measuring and improving quality through the use of technology.
Adult primary care clinics. Stratis Health assisted nearly 80 clinics with improving care management practices by advancing the implementation of electronic health records (EHR). By replacing paper medical records with EHR systems, clinics can leverage technology to enhance care management of patients, particularly the chronically ill.
- 77% of participating clinics implemented an EHR system
We worked with 23 adult primary care clinics across Minnesota—both urban and rural—to reduce language and cultural barriers to effective health care by engaging physicians and staff to better understand the changing demographics of their patient base and to build more culturally relevant approaches to care delivery into their practices.
- Statistically significant performance improvement on all 14 national Culturally and Linguistically Appropriate Services (CLAS) standards, from baseline to re-measurement, by the participating clinics.
Hospitals. Stratis Health worked with hospitals across the state to improve patient care and data reporting, and to integrate patient safety related technology—such as computer bar codes on patient wristbands and computerized physician orders—into their systems of care to reduce human errors and avoid dangerous medical mistakes.
- Nation-leading results in quality measures, including 10% improvement statewide in measures of appropriate care in patients with a diagnosis of heart failure, acute myocardial infarction, or pneumonia
- Eight of the nine hospitals assisted made progress toward implementing medication bar coding
By integrating quality improvement processes into organizational culture, Stratis Health promoted an improved safety environment in nine rural critical access hospitals.
- 2.4% improvement from baseline to remeasurement on the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture Survey
Nursing homes. To assist Minnesota’s approximately 400 nursing homes in creating healthier, more enjoyable communities for their residents, Stratis Health provided quality improvement tools, training, and resources. We helped launch the Minnesota Culture Change Coalition, a coalition of stakeholders in longterm care interested in broadly fostering person-centered care.
- Supported 53 nursing homes in a collaborative focused on reducing physical restraints, pain, and pressure ulcers; lowering workforce turnover; and moving from an institutional environment to one that is person-centered.
- 1.7% decrease in pressure ulcer rate for high-risk patients in 53 nursing
Home health agencies. More patients received appropriate care in the comfort of their homes and avoided costly hospital stays due to a close partnership between Stratis Health and a select group of home health agencies.
In addition to providing training and resources on avoidable acute care hospitalization, oral medication management, immunization assessment, and vaccination to Minnesota’s approximately 200 home health agencies, Stratis Health supported 62 home health agencies working on clinical quality improvement, focusing on improving the use of telehealth and changing organizational culture to be patient centered and focused on quality.
- 36% improvement statewide in assessing patients for flu and pneumococcal immunizations
- 6.3% reduction in avoidable hospitalizations for the 62 agencies, a statistically significant improvement
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