Acumentra Health is the Medicare Quality Improvement Organization (QIO) for Oregon. As a QIO, Acumentra Health is part of a national network of organizations with a statutory mission to improve the effectiveness, efficiency, economy, and quality of services provided to Medicare beneficiaries.
Managed by the federal Centers for Medicare & Medicaid Services (CMS), QIOs in each state carry out two primary roles:
- protecting beneficiaries’ right to receive necessary medical care, through medical record review
- guiding healthcare providers in measuring and improving care, through initiatives with providers and stakeholders
Initiatives with providers and communities
In August 2011, Acumentra Health began its 10th three-year cycle of work as a Medicare QIO, launching an exciting array of initiatives that build on Oregon providers’ achievements in previous projects and support the 2011 National Strategy for Quality Improvement in Health Care. The initiatives bring a new dimension of dynamic support for community-based learning and change, including learning and action networks (LANs)—focused collaborative initiatives that engage multiple providers or care settings within a community to address common goals.
QIO Program Strategic Aims and Drivers
Acumentra Health is a convener and change agent for reaching the CMS Three-Part Aim for transforming the healthcare delivery system: Better care for individual patients, better health for populations, and lower healthcare costs through improvement.
The QIO Program translates the Three-Part Aim into initiatives focused on four Strategic Aims:
- Beneficiary- and Family-Centered Care through case review
- Improving Individual Patient Care
- Oregon HAI Prevention Coalition (hospital LAN)
- Pressure Ulcer & Restraint Reduction Project (technical assistance for nursing homes)
- Oregon Resident Safety & Quality Collaborative (nursing home LAN)
- Patient Safety & Clinical Pharmacy Services Collaborative (PSPC) (local clinic teams in national LAN to reduce adverse drug events)
- Quality Reporting and Improvement (hospital data reporting, Value-Based Purchasing)
- Integrating Care for Populations and Communities
- Community-based care transitions initiatives to reduce hospital readmissions (cross-setting transitional care improvement with providers in specific communities)
- Improving Health for Populations and Communities
- Cardiac Health Network (supporting medical practices in reporting EHR data and improving health of cardiac patients)
- Preventive Care & HIT Network (assistance to medical practices with newly installed EHRs)
- PQRS EHR Reporting Project (promoting successful participation in the federal Physician Quality Reporting System incentive program via EHR)
QIOs use three Drivers to implement the Strategic Aims:
- Learning and action networks
- Technical assistance to providers and practitioners
- Care Reinvention through Innovation Spread (CRISP; approaches for learning and communication)
Similar to IHI Breakthrough Series Collaboratives, LANs are mechanisms for fostering large-scale improvement toward a specific aim. A LAN convenes appropriate stakeholders, providers, and improvement experts in an “all-teach, all-learn” model that encourages peer sharing, rapid testing of change ideas, and support for adaptation and spread of successful improvements. LANs typically involve periodic face-to-face or virtual learning and reporting sessions, as well as action periods for trying new approaches and monitoring progress in the care setting.
The LANs are intended to bring together diverse stakeholders, using their different perspectives to plan effective responses. Acumentra Health draws from an advisory council for each LAN to help inform activities with care providers and other stakeholders. The voice and experience of Medicare beneficiaries is a guiding force in these QIO initiatives, and our LANs also include patient representatives as stakeholders—embodying the principle “Nothing about me without me.”