This Annual Report intends to demonstrate to Medicare beneficiaries, caregivers, health care providers, quality improvement leaders, government officials and others how the Centers for Medicare & Medicaid Services (CMS) Network of Quality Improvement and Innovation Contractors (NQIIC) Program has supported quality improvement efforts across care settings, using data to drive change and add value to taxpayers. It highlights the work completed during the inaugural year (November 2019 – November 2020) of the NQIIC Program. During this one-year period, at CMS’ direction and under CMS’ vision, 12 Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) began working with health care providers, community stakeholders, Medicare beneficiaries and caregivers on data-driven initiatives designed to improve health care quality.  

While additional quality improvement programs have since been awarded under the NQIIC Program, their work had not yet begun during the time span of this report. Therefore, while this report primarily focuses on the successes of the QIN-QIOs through November 2020, it also looks ahead to opportunities for collaboration among the new quality improvement programs. Activities initiated or continuing after November 2020 will be contained in the next Annual Report.

Letter from Acting Director, iQuality Improvement & Innovation Group (iQIIG), Anita Monteiro

picture of Anita Monteiro, acting director iQuality Improvement & Innovation Group (iQIIG)

Over the past year, the U.S. health care system has faced challenges like never before. The COVID-19 pandemic has required providers in every health care setting to demonstrate resiliency and adapt to new working conditions, while ensuring quality and safety to protect our most vulnerable populations, including nursing home residents, dialysis patients and Medicare beneficiaries everywhere. Despite the difficulties presented this year, Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) within the Network of Quality Improvement & Innovation Contractors (NQIIC) worked diligently, at CMS direction, to uniquely reposition themselves to improve health care quality for Medicare beneficiaries across the country in the midst of the pandemic reality.

The Centers for Medicare & Medicaid Services (CMS) kicked off the year with a successful CMS Quality Conference, which convened more than 3,500 patients, advocates, providers, researchers and health care quality improvement leaders to develop and spread solutions for some of the country's most pervasive health care challenges. Highlights of this conference included CMS Administrator Seema Verma providing a look at the new CMS Quality Strategy. Dr. Robert Montgomery, a heart transplant recipient, and Precious McGowan, a kidney transplant recipient, spoke about their health care journeys and reminded us of the meaning behind the challenging work we do. It was at this conference that Assistant Secretary for the Department of Health and Human Services, Admiral Brett P. Giroir, first warned attendees about the illness spreading through Asia and Europe that would soon be known worldwide as the COVID-19 pandemic.

The 15,000 nursing homes in the U.S., with their vulnerable populations housed 24/7 in close proximity to one another, emerged as “ground zero” for the pandemic and became the main focus of our initial COVID-19 response. Nationwide, deaths in long-term care facilities accounted for 40 percent of all COVID-19 deaths. Nursing home staff members became infected at a higher rate than the general population, and also suffered higher mortality.  

Prior to the pandemic, the QIN-QIOs had just begun recruiting nursing homes to participate in their technical assistance programs based on CMS’ then-non-pandemic goals. As we saw the speed and severity with which COVID-19 was spreading throughout nursing homes, we recognized that our existing approach to training and intervention would not provide the impact nursing home staff, residents and their families desperately needed. We immediately reprioritized the QIN-QIOs away from their previous remote and generalized technical assistance to an onsite, rapid-response force capable of providing direct assistance to nursing homes struggling to respond to COVID-19 outbreaks and failures of adequate infection control under conditions never before seen in the U.S.  None of us in our lifetimes have ever experienced a global outbreak of a deadly, highly contagious airborne viral disease. This was a new problem, and it required an entirely new, urgent response from government and regulatory agencies such as CMS.

We began our work by adopting a strategic view of the QIO Program mission, not as “providers of services” but as “responders to need” so we could orient our operations in a different light. As a result, we rightly began to see the public health crisis as a critical and unprecedented opportunity to challenge ourselves to be innovative and directly impactful. Since April 2020, the QIO Program has provided technical assistance to over 8,000 nursing homes, 3,489 of which experienced severe COVID-19 outbreaks and received direct one-on-one technical assistance. We also developed and provided a first-of-its-kind CMS Targeted Nursing Home Training for Frontline Staff and Management in August 2020. Over 300,000 nursing home staff and managers have completed the training, encompassing 73 percent of nursing homes in the U.S.

I am convinced that the closing words at the 2020 CMS Quality Conference from then-Acting Director for the CMS Center for Clinical Standards and Quality, Jean Moody-Williams, are perhaps even more relevant now than they were at the start of 2020: "We are now empowered to go home and change the world. Go out and make a difference in someone's life. And make sure at the end of the day we can say, 'it is good.'"

During this upcoming year, I am eager to work together to continue to shape and implement a program that focuses on those who need it most. Keeping our mission and vision in mind, we will be strategic in our efforts, focus on making a real impact and remain as adaptable as possible.

This is why I do this work, and why I am proud to call you my partners in health care quality improvement. Thank you for your expertise, your heart and your drive to make health care better for the hundreds of thousands of people in need this year – and every year.

— Anita Monteiro, Acting Director, iQuality Improvement & Innovation Group (iQIIG)

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