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Sale of Noncompliant Health Plans Prompts Debate over Transitional Policy

By Rebecca Adams, CQ HealthBeat Associate Editor

May 9, 2014 -- The Centers for Medicare and Medicaid Services (CMS) said last week that it will phase in a restructuring of the Quality Improvement Organization Program that the agency believes will be more efficient and save money.

During the first phase of the restructuring, two of the private contractors that help CMS with quality improvement efforts will take a lead role in working with the program's case review and monitoring activities. That work will be done separately from the traditional quality improvement activities that contractors do.

The companies will focus on ensuring consistency in the review process and taking into account local factors in decisions. CMS announced that it has selected two contractors to do that work: Livanta LLC, located in Annapolis Junction, Md., and KePRO, located in Seven Hills, Ohio.

During a second phase, CMS will award contracts to organizations that will directly work with providers and communities on quality initiatives to improve patient safety, reduce harm, and improve clinical care.

The trade association for quality improvement organizations (QIO) said it supported the changes.

Todd Ketch, executive director of the American Health Quality Association, said the changes "will place even greater emphasis on improving the health status of communities; providing beneficiary-centered, reliable, accessible and safe care and providing better care at a lower cost."

He added, "In the years ahead, QIOs will continue to focus on improving the way in which providers coordinate patient care across settings, reducing health care associated infections, improving care for high-incidence conditions like diabetes and heart disease, and more. We applaud CMS' commitment to continuing to provide boots-on-the-ground QIO technical assistance that has been integral to national quality improvement efforts."

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