PR, SC, TN, TX, VA, WA, WI. Contracts were awarded to: DC, GA, LA, MD, NY and Virgin Islands. The QIO identified both the practice and the ancillary organizations (e.g., community health centers, senior centers, faith-based organizations, etc.) that it would work with as part of the CMS-approved Diabetes Self-Management Education (DSME) process. The QIO facilitated training of appropriate personnel (e.g., nurses, Certified Diabetes Educators (CDEs), Community Health Workers (CHWs), etc.) at the identified organizational sites using evidence-based DSME programs within the underserved population of the Participating Practices (PPs). The QIO was required to establish a partnership with the primary care physician (PCP), CDE, and CHW to facilitate the accessibility of DSME services to patients. The QIO was required to work with the PPs to improve/increase their adherence to clinical guidelines for appropriate use of utilization measures for HbA1c, Lipids, and Eye Exams, as evidenced by Medicare claims billed by physicians for beneficiaries in priority populations with diabetes. The chart below identifies the Disparities 28th month evaluation measures, targets, and results. Measures Targets Results Maintain % recruitment 80% of the participating practices 100% pass Increase % of beneficiaries completing DSME training 55% of recruited beneficiaries had to complete DSME HbA1c 8% Reduction in failure Rate 100% pass Eye Exam 4% Reduction in Failure Rate 100% pass Lipids 8% Reduction in Failure Rate 100% pass
O-5a (CHF) Reduce rate of readmission by at least 2 percentage points from the baseline rate in at least one of the specific diagnoses O-5 measures were removed from contract evaluation. 0-5b (AMI) Reduce rate of readmission by at least 2 percentage points from the baseline rate in at least one of the specific diagnoses O-5 measures were removed from contract evaluation. O-5c (PNE) Reduce rate of readmission by at least 2 percentage points from the baseline rate in at least one of the specific diagnoses. O-5 measures were removed from contract evaluation. O-1a 8% relative reduction in failure rate from baseline 36% of QIOs achieved (5/14) O-1b 8% reduction in baseline failure rate from baseline 71% of QIOs achieved (10/14)
O-2 8% reduction in failure rate from baseline 21% of QIOs achieved (3/14) O-3 1 or more interventions, affecting at least 10% of transitions must show improvement 100% QIOs achieved (14/14) O-6 8% relative improvement from baseline This measure was removed from contract evaluation. Measure O-4 is the number of readmissions per 1000 Medicare FFS beneficiaries residing in the specified geographic area that occur within 30 days of discharge from an acute care hospital Measure O-5a is 30 day all-cause risk standardized readmission rates following Measure O-5b is 30 day all cause risk standardized readmission rates following AMI hospitalizations. Measure O-5c is 30 day all risk standardized readmission rates following pneumonia hospitalizations. Measure O-1a is % of patients over 65 years who rate hospital performance meeting performance standard for medication management Measure O-1b is % of patients over 65 who rate hospital performance meeting performance standard for discharge planning Measure O-2 is % of patients discharged and readmittted within 30 days who are seen by a physician between discharge and readmission Measure O-3 is % of patient care transitions (FFS Medicare), in the specified geographic area, for which implemented and measured interventions show improvement