How pharmacists are working with CMS’s QIN-QIOs

Ways to engage to improve health care quality for Medicare patients

Pharmacists should know about Quality Improvement Organizations (QIOs) or Quality Innovation Networks (QINs).

“I definitely think there’s a lack of awareness,” said Katy Brown, PharmD, who is now the medication safety task lead for the Telligen QIN and clinical pharmacy specialist for both the Iowa and Colorado QIOs.  

Each state has a QIO, but each one operates within a QIN. Telligen is the QIN-QIO for Iowa, Colorado, and Illinois.

CMS created QIN-QIOs, which the agency has named them, under the Social Security Act and relies on them to improve the quality of health care for Medicare beneficiaries. QIN-QIOs work with providers and practitioners across communities in every state to reduce adverse drug events and improve medication safety, especially when it involves opioids, anticoagulants, and diabetes medications.

“Pharmacists are a key stakeholder in this work,” said Anita Thomas, PharmD, CMS’s QIO patient safety program lead.

QIN-QIOs can share data and educational support that relates to adverse drug event reduction and find ways to improve medication safety.

Reducing hospital readmissions

As payment moves from fee for service to a value-based model, health care providers, including pharmacists, will be required to implement and understand the quality improvement process as well as measure their performance to demonstrate value.  

Transitions of care is one area pharmacists can have an immediate impact.

“This scope of work lends itself to greater pharmacy involvement where medication safety is at the forefront of readmission rates,” Brown told Pharmacy Today.

Hospitals are now being penalized for excess readmissions through the Hospital Readmissions Reduction Program, which was enacted as part of the Affordable Care Act.

Jennifer Thomas, PharmD, medication safety/adverse drug event lead for the Atlantic QIN for the District of Columbia, said that one of the pharmacy representatives they work with expressed that partnering with the QIN-QIO helped hospitals learn about bedside delivery programs, which in turn allowed the pharmacy to “achieve the first fill [adherence] for the discharged patient and subsequent refills with the pharmacy.”

Thomas said pharmacies should be aware that quality improvement initiatives may affect CMS star ratings, payer networks, and community perception of pharmacy services now and in the future. In addition, these initiatives may be required to determine preferred networks for third party payers, including Medicare Part D.

It could also be key for provider status by allowing pharmacists to demonstrate definitive ways they can affect medication safety and reduce hospital readmissions.

QIN-QIOs in action

Pharmacies are actively seeking help from QIN-QIOs. NuCara Pharmacy, one of the pharmacies Brown works with, is interested in exploring clinical services, seeking payment to maintain their business, and helping to achieve provider status recognition for pharmacists.

In particular, they are looking at cost savings and outcomes improvement of pharmacist comprehensive medication management through physician referrals.

“They are assessing the risk of the patient based on the medications they are taking and analyzing their recommendations not only in the cost of care but in things like adherence and preventing adverse drug events,” said Brown.

She said she has also begun doing a lot of work with medication reconciliation.

“That breakdown of communication in the community is causing huge problems in preventing safe use of medication as it relates to transfer or discharge,” said Brown.

Take initiative

Overall, Brown said pharmacists can elevate the care they provide through their involvement with QIN-QIOs. The support pharmacies gain is also free of charge since QIN-QIOs are already funded.

“The fact that every QIN-QIO doesn’t have a pharmacist speaks to the fact that this is a new direction,” said Brown. “I would advocate that we need to do a better job of reaching out through our associations to those providers who are interested in our support.”

Ways to be involved with CMS’s QIN-QIOs

  • Participate on community coalitions and workgroups.
  • Participate on a QIN-QIO advisory board.
  • Design and implement medication safety processes and interventions.
  • Share medication safety processes and interventions.
  • Actively screen high-risk medication patients for medication adverse events.
  • Share data about medication safety interventions, outcomes, and quality improvement projects.
  • Engage other community practitioners, patients, families, and caregivers about the importance of medication safety and adverse drug events.
  • Receive technical assistance and/or education from the QIN-QIO on medication safety, specifically for opioids, anticoagulants, and diabetes medications.