In August 2014, the Centers for Medicare & Medicaid Services (CMS) established a new functional structure for the Quality Improvement Organization (QIO) Program that delivers program value to Medicare beneficiaries and their families, maximizes learning and collaboration for improving care, and supports the spread and sustainment of effective new practices and models of care. The Program separated the review of Medicare beneficiary quality of care concerns and appeals from quality improvement work carried out in provider and community settings. Two Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs), covering all 50 states and three territories, address quality of care concerns and appeals, while 14 Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) work with providers, stakeholders, and Medicare beneficiaries to improve the quality of health care for people with targeted health conditions.
These fact sheets provide information about the QIO Program and its alignment with the National Quality Strategy to provide safe and affordable health care to the entire U.S. population in every community.
Quality Innovation Network-Quality Improvement Organizations
QIN-QIOs help patients and families, providers, and communities make care safer, support active engagement and self-management of chronic conditions, eliminate health disparities, promote best practices for healthy living, deliver improved access to care, and make care affordable.
Beneficiary and Family Centered Care-Quality Improvement Organizations
BFCC-QIOs address all beneficiary concerns and appeals, quality of care reviews, cases of suspected “patient dumping” covered by the Emergency Medical Treatment and Labor Act (EMTALA), and other types of case reviews. The two BFCC-QIOs, Livanta and KEPRO, serve all 50 states and three territories.
Improving the Health Status of Communities
QIN-QIOs focus on improving cardiac health, reducing disparities in diabetes care, improving adult immunization rates and improving identification of depression and alcohol use disorder in primary care and care transitions for behavioral health conditions.
Safe Care that is Person- and Family-Centered, Reliable and Accessible
QIN-QIOs are working with communities to combat antibiotic resistant bacteria through antibiotic stewardship, reducing health care-acquired conditions in nursing homes, promoting effective care coordination and communication, and improving medication safety.
Coordinating Better Care & Lowering Costs
QIN-QIOs provide technical assistance to large practices participating in the Quality Payment Program and help hospitals and other facilities understand and participate in CMS quality reporting programs such as the Hospital Inpatient, Hospital Outpatient, Ambulatory Surgery Center, Inpatient Psychiatric Facility and Prospective Payment System-exempt Cancer Hospital reporting programs.