Ensuring Quality and Integrity

Improving health care quality and safety for patients is at the heart of all the work QIOs do. QIOs, which are independent and mostly not-for-profit organizations, ensure quality and integrity in health care in several ways.

Working locally in communities across the nation, QIOs provide direct technical assistance to health care providers to improve care delivery. This work supports the U.S. Department of Health and Human Services’ National Quality Strategy and broad national goals such as reducing health care-acquired infections, reducing deaths from heart attack and stroke, improving preventive care, and broadening the use of electronic health records to support health care quality improvement efforts.

From physicians and nurses to administrators and analysts, QIO teams in every state have a deep knowledge of and experience in the health care industry. These experts provide evidence-based tools for providers across the continuum of care, and build trusted relationships as they work side-by-side with others to improve care and care processes. QIOs augment hands-on training with group training opportunities such as webinars, training calls and state-based educational conferences. QIO experts in data analytics and trends collect and report facility- and state-level data on quality of care, work with providers to track progress through data reporting, and address challenges during the adoption of improved processes and proven best practices.

In addition to their work with providers, QIOs advocate for Medicare beneficiaries by reviewing appeals of termination of coverage and quality of care concerns voiced by patients or family members. Each QIO maintains a statewide Medicare beneficiary complaint help line staffed by professionals who are trained to help patients report quality of care concerns. QIOs coordinate reviews of cases by independent physicians located in the state where the care was provided. In many instances, concerns can be quickly resolved through a process called immediate advocacy, where a QIO staff person calls the provider and works to clear up miscommunication or other concerns voiced by the patient or a family member. By reviewing beneficiary concerns, QIOs often identify system-wide quality improvement opportunities and work directly with providers to implement interventions that make care safer for hundreds or thousands of patients.

With their close community ties, independent status, and established track record, QIOs are uniquely positioned to conduct necessary oversight, which is in the best interest of patients and providers alike.