Evaluation of QIN-QIO Improving Coordination of Care for Medicare Beneficiaries

The Centers for Medicare and Medicaid Services (CMS) Quality Innovation Network (QIN) Quality Improvement Organization (QIO) program accelerates improvement in effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. The Independent Evaluation Center (IEC) for the 11th Statement of Work (SOW) of the QIN-QIO program evaluated the Coordination of Care (CoC) program which focuses on deliberate organization of patient care activities between two or more participants to facilitate the appropriate delivery of health care services to a patient across care settings.

Our analyses considered on four outcome measures: admissions, readmissions, emergency department (ED) visits, and observational stays. We used a Market Share Analysis (MSA) approach to determine the impact of the QIN-QIO program accounting for other healthcare programs and policies to which the same beneficiaries were exposed during this time: the Partnership for Patients (PfP) and Accountable Care Organizations (ACO). All Medicare fee-for-service beneficiaries between 2014 and 2017 were included in the study sample. Sampling and matching were conducted to produce comparable QIO and non-QIO groups. Various cross-sectional and longitudinal models including Generalized Linear Mixed Effect model and Generalized Estimating Equations were used to estimate the number of outcomes averted, cost savings, and return on investment (ROI).

Between 2014 and 2017, hospital utilization decreased across all 4 outcomes. We estimated QIN-QIO program is associated with reductions of 402,377 (95% CI: 96,427 to 712,258) ED visits, 63,619 observation stays (95% CI: 2,455 to 127,459), 39,155 admissions (95% CI: -143,695 to 244,522), and 47,778 readmissions (95% CI -41,075 and 140,213). These translate into statistically significant cost savings from ED visits ($445M; 95% CI: $107M to $788M) and observation stays ($122M; 95% CI: $5M to $244M) with no statistically discernable impact on admissions and readmissions. Total cost savings were estimated to be $567M (95% CI: $200M to $1,349M). The return on every $1 invested in the QIN-QIO program was $4.83 (95% CI: -$1.15 to $13.50).

The QIN-QIO Coordination of Care program has already significantly reduced the number of ED visits and observation stays, in the first 3.5 years of this 5-year contract. Reducing ED visits and Observation stays will yield significant improvements in cost, quality, and patient experience of care. Avoidable ED visits negatively influence patients’ experience of care and are associated with longer inpatient stays, cost, and in some studies, mortality. Observation stays impose higher cost sharing on beneficiaries, and are followed by rehospitalization at the same rate as ED visits, with about half of those revisits resulting in an inpatient admission. Cost savings trends for admissions and readmissions show positive trends but are not statistically significant at the 3.5 year milestone.