Center for Excellence in Rural Health-Hazard

Health Care Excel to collaborate with Ky. providers on behalf of Medicare beneficiaries

BY ELLEN MURPHY − HEALTH CARE EXCEL

In August, the Centers for Medicare & Medicaid Services (CMS) marked a bold, new direction in improving health care services for Medicare beneficiaries. Between now and July 2014, CMS is launching a series of projects led by the Quality Improvement Organization (QIO) Program. Health Care Excel, the Medicare QIO for Kentucky, is focusing on three aims for seniors: better individual patient care, better population health and lower health care costs by improvement through the following efforts:

• Fulfilling CMS’ obligation to protect the rights of Medicare beneficiaries by reviewing quality of care concerns and appeals, as well as denial or discontinuation of health care services. The QIO advocates for beneficiaries and their families to be meaningfully involved in QIO improvement and prevention activities.
• Working with hospitals to achieve as much as 50 percent reductions in health care-associated infections that will contribute to as much as a 50 percent reduction in national HAI rates. The initiative will reduce central line-associated blood stream and catheter-associated urinary tract infections by implementing the Comprehensive Unit-Based Safety Program, Clostridium difficile and surgical site infections.
• Contributing to a 40 percent national reduction in health care-acquired conditions, such as catheter-associated urinary tract infections and falls. The QIO also is working with nursing homes to improve pressure ulcer prevention and reduce physical restraint use.
• Improving the quality of care for high-risk Medicare patients by working with clinical pharmacists, primary care clinics and other providers that care for older patients with multiple chronic conditions to reduce adverse drug events. The initiative focuses on increasing patient self-management skills, reducing unnecessary hospital readmissions, and forming community relationships to ensure community-wide adoption of improved practices.
• Assisting physician practices that want to use their electronic health record system to coordinate preventive services like flu and pneumococcal immunizations, along with colorectal and breast cancer screenings. The QIO is partnering with local health information technology regional extension centers to promote HIT integration into clinical practice.
• Collaborating with hospitals, nursing homes, home health agencies, dialysis facilities, physician practices, patient advocacy organizations and other stakeholders to reduce hospital readmissions. The QIO will assist in the goal of reducing hospital readmissions within 30 days of discharge by 20 percent over three years by changing processes of care at the community level.

New ways to work together

New models for accelerating and spreading change have shaped Health Care Excel’s approach to working with health care providers and partners. Providers and partners have more and different ways to be a part of QIO initiatives. Health Care Excel is convening statewide Learning and Action Networks (LAN) that recognize everyone’s knowledge and contribution to better health care. Through an “all teach all learn” large-scale LAN approach, the QIO will accelerate the pace of change and rapidly spread best practices. Improvement initiatives include collaborative projects, online interaction and peer-to-peer education.

Learn more and become involved

The QIO Program invites all health care providers, Medicare beneficiaries, family members, caregivers and other health quality stakeholders and partners to be part of these new improvement initiatives. More information about the QIO Program is available online at www.hce.org or by calling (502) 454-5112.

Become a physician reviewer

For information on how to become a physician reviewer for Health Care Excel’s Beneficiary and Family Centered Care initiative, go to How to Become a Physician Reviewer, contact Cheryl Riddell, program manager, at criddell@inqio.sdps.org, or call (812) 234-1499, extension 237.