"Simultaneously achieving quality health care and costs savings can be done."
By Harold Ambler Contributing Writer
John Keimig has served as the president and CEO of Healthcentric Advisors since 2007. Healthcentric is a Rhode Island-based nonprofit advisory organization providing health care quality improvement and patient safety education, consulting, research and technical support. The Centers for Medicare & Medicaid recently awarded Healthcentric a $53.4 million contract, as part of CMS’ Quality Innovation Network-Quality Improvement Organization program, to provide Medicare quality improvement services to all six New England states. Prior to joining Healthcentric, Keimig spent more than 25 years in health care executive leadership positions including 16 years as president and CEO of St. Joseph Health Services of Rhode Island.
PBN: This $53 million award is significant, especially considering that is for six states versus the previous single-state contract. How many employees does Healthcentric have, and will it need to scale up to do the work that the contract is for?
KEIMIG: Healthcentric Advisors has approximately 35 associates. The vast majority of our associates will continue on with the work they were performing during our previous QIO contract.
Healthcentric Advisors, as the prime contractor, is responsible for the overall administration of the contract and will primarily focus its efforts in Maine, Massachusetts and Rhode Island. We have engaged Qualidigm, the incumbent QIO for Connecticut, to assist us in performing some aspects of the contract. Qualidigm will focus its efforts on Connecticut, New Hampshire and Vermont.
Some employees from the Massachusetts incumbent QIO, Masspro, will be joining our staff to assist with the transition for Massachusetts-based providers. We will also be hiring associates in both Rhode Island and Massachusetts. In addition, we are working closely with key stakeholders in northern New England to identify opportunities to leverage already existing infrastructures to support our work.
We do anticipate opening satellite offices in Massachusetts and northern New England so that we can offer the same level of support to providers in the northern New England states that we offer to our partners in Rhode Island and Qualidigm provides to its partners in Connecticut.
PBN: How will Healthcentric Advisors save CMS money?
KEIMIG: The Centers for Medicare & Medicaid Services (CMS) prescribes the initiatives that we must implement with providers. In this new chapter of QIO work, CMS’s goal is to improve the value of health care by improving the quality of care, improving the health of beneficiaries and in turn, lowering overall health care costs. As a QIN-QIO we are charged with implementing quality improvement initiatives that tackle this 3-part aim of better health, better care and lower costs.
For instance, as part of the QIN-QIO contract we will continue working with hospitals to reduce healthcare-associated infections (HAIs). This is a continuation of work that started during our previous QIO contract. During the previous contract period (August 1, 2011-July 31, 2014) eight Rhode Island hospitals reduced C.difficile rates by 20%. C. difficile is an infection that often leads to longer, more expensive hospital stays.
Another example of how our work not only improves care, but also helps to reduce or avoid unnecessary health care costs is our nationally-recognized Safe Transitions initiative which started six years ago and will continue as part of the QIN-QIO contract. The ultimate goal of this initiative is to ensure that every patient has a positive and successful transition between settings – therefore reducing the number of avoidable hospital readmissions. We work with providers, using cross-setting community coalitions to target the root causes of poor transitions, then use a collaborative, all-share, all-learn approach to implement quality improvement programs to improve transitions of care and reduce avoidable readmissions. During the 2011-2014 contract period Rhode Island providers reduced statewide readmissions overall by 20.2%, avoiding nearly 1,500 readmissions and $13.9 million in Medicare expenditures.
Those are just a few examples of how the QIN-QIO program helps in the national effort to provide better care, improve the health of beneficiaries and lower costs.
PBN: Is simultaneously achieving cost savings and better health outcomes a great challenge with a disease such as diabetes, for example?
KEIMIG: Simultaneously achieving quality health care and costs savings can be done. QIN-QIOs are charged with working with providers to improve health care, support the creation of healthy people in healthy communities and lowering costs. The crux of the issue lies in chronic disease prevention. A big change from our previous QIO contracts is the increased focus on population health and chronic disease prevention.
As part of the QIN-QIO contract we will work closely with primary care providers in the management of chronic diseases. Specifically, working to improve cardiac health and reduce health care disparities, promoting health literacy, engaging patients and families in their care. We will also work to increase the number of diabetes training sites and educators, along with engaging patients and families in diabetic self-management using targeted clinical outcomes measures to track success and highlight areas for further improvement.
PBN: Did your bid to CMS indicate how much you expected to save the federal government? How much do you expect to save CMS?
KEIMIG: The bid for the QIN-QIO contract is specific to administering quality improvement initiatives in various health care settings-hospital, home health, long-term care and physician office. CMS dictates which quality improvement initiatives the QIN-QIOs will administer. The current QIN-QIO focus is one of the three primary areas that are the fastest growing portions of Medicare in terms of expenditures – avoidable hospital readmissions, chronic diseases and health care associated events such as infections acquired in hospitals and conditions acquired in nursing homes. By focusing our quality improvement efforts on these three cost drivers CMS hopes to slow the growth of Medicare costs even as the baby boomer generation becomes eligible for Medicare.
In addition, we are also tasked with promoting high-quality and more efficient health care for patients by assisting 100% of providers with value-based payment modifier, value-based purchasing, quality reporting (hospitals) and electronic reporting (physicians).
PBN: If I’m a Rhode Island-based hospital, how do the nuts and bolts of this contract work? Does Healthcentric Advisors possess authority over how I do business? Will you and do you have staff working in the state’s hospitals?
KEIMIG: Healthcentric Advisors does not possess authority over how a hospital does business. Our relationship with hospitals is one of a neutral convener that brings together facilities throughout the state to work together in implementing quality improvement initiatives. CMS pays us to provide advisory services, education and the technical assistance to support the hospitals in these targeted quality improvement initiatives. The hospitals pay nothing to participate. We do ask for their commitment to the projects and active participation in our collaborative model.
Over the past 18 years we have forged strong relationships with the local health care community, and not just with hospitals, but also with nursing homes, the physician office community, home health agencies and many of the local and national trade associations. Because of those established relationships we are able to build upon our previous contract work. Depending on the initiative our associates may provide on-site technical assistance, when warranted.