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Evolution of Medicare Quality

Mary Lou Haider
Mary Lou Haider
Vice President, Contract
Management and Internal Quality,
Stratis Health

Nearing retirement, I am reflecting on my time at Stratis Health, which has included locally and regionally overseeing and managing our program focused on improving quality of care for Medicare beneficiaries. The program has evolved over time from a focus on individual case review and quality improvement to leveraging collaboration and community. Program changes gave us new names and stirred the alphabet soup, with Peer Review Organizations (PRO), Quality Improvement Organizations (QIO), Quality Innovation Networks (QIN), and now Network of Quality Improvement and Innovation Contractors (NQIIC).

The evolution of the Medicare Quality Improvement Program has happened at a pace that has both brought along and challenged the health care community.

Individual beneficiary, provider focus

I joined Stratis Health in March 2000 when we were the Medicare PRO for Minnesota. Our work focused on quality assurance through chart reviews and beneficiary complaint follow up, along with targeted quality improvement efforts with individual hospitals and clinics.

Collaboration and networks

In 2002, PROs became QIOs to reflect program expansion to include quality improvement efforts and working with providers of health care services across settings of care. QIOs were CMS's state-based boots-on-the-ground to provide technical assistance and tools, and to share best practices. Stratis Health brought together Minnesota health care organizations in setting-based groups using the new Institute for Healthcare Improvement Breakthrough Collaborative model.

Over time, it became clear that improvement efforts could be enhanced by working with other stakeholders and organizations that have common quality and performance improvement goals. Collaborative efforts produced greater results than what individual efforts could achieve on their own and used resources more efficiently.

In 2011, learning and action networks became the model for bringing together stakeholders, partners, providers, and beneficiaries to accelerate the pace of change. A successful example is the Reducing Avoidable Readmissions Effectively (RARE) Campaign, led by Stratis Health, the Minnesota Hospital Association, and the Institute of Clinical Systems Improvement, to prevent avoidable readmissions in Minnesota. We were joined by 86 hospitals and more than 100 community partners across the state to prevent 7,975 avoidable hospital readmissions.

Regional partnering and community approach

In 2014, CMS redesigned the QIO Program to have a regional approach. Stratis Health partnered with the longstanding QIOs in Michigan (MPRO) and Wisconsin (MetaStar) to deliver assistance as Lake Superior QIN. We scaled learning collaboratives to three-states while retaining local assistance delivery when needed. Working together expanded the number of collaborators with common goals—our stakeholders, partners, providers of health care and community services, and Medicare beneficiaries and family members. As we wrap up this work, successes include 73,546 fewer unnecessary readmissions and admissions, 7,900 fewer nursing residents taking antipsychotic medications, and 94 percent of participating organizations implementing an antibiotic stewardship program with all core best practice elements.

Aligning CMS quality programs

In 2019, CMS is integrating all of its quality programs into NQIIC. This restructuring brings together the QIN-QIOs, End Stage Renal Disease Networks, Hospital Improvement Innovation Networks, and Practice Transformation Networks.

Stratis Health is evolving too. We are partnering with seven other organizations that have all served CMS in the various quality programs to be an NQIIC. As the new Superior Health Quality Alliance, we will support further collaboration and alignment to achieve national quality goals.

Thank you to all of the individuals and organizations that have been on this incredible journey with me and with Stratis Health. As I prepare to step away from shepherding this work for Stratis Health, I know Minnesota health care professionals are ready to work toward the next set of Medicare quality goals. You've always stepped up to make lives better.