Friday, November 22, 2024

CMS Draft SOW: Quality Improvement Network-Quality Improvement Organization (QIN-QIO)

Description

CMS will define a CMS-designated technology solution to support workflows, operational dashboards and analytics.

The purpose of this task is to modernize the QIN-QIO program with advanced mechanisms for data and information exchange between CMS and the QIN-QIO through innovative, state-of-the-art, secured and well scoped technology solutions. This aims to drive informed decision-making based on evidence, ensuring the success of the QIN-QIO program and its positive impact on Medicare beneficiaries and local communities.

To increase CMS’ ability to discover, view, and access data as soon it becomes available from the contractor.  A CMS-designated IT solution  will be defined by CMS, serving as a designated technology solution  to manage and automate important functions such as workflows, correspondence, and performance monitoring. Overview

CMS contractors shall use the CMS-designated technology solution, to process all required workflows and capture all data elements in real time and in standardized form. The technology solution will collect, attribute, analyze, and synthesize data from a range of sources and generate meaningful reports, dashboards and insights. The solution will offer the flexibility to easily adopt to future CMS initiatives in support of new and changing business priorities. CMS will define  data requirements to ensure QIN-QIO compliance with guidelines and regulations when applicable. The QIN-QIO shall demonstrate flexibility and knowledge to quickly adapt to evolving data and IT requirements. These include but is not limited to new products or enhancements within the CMS-designated solution  and adoption of other requirements such as Fast Healthcare Interoperability Resources (FHIR) standards. CMS reserves the right to designate use of alternate systems if needed.

General Requirements

The QIN-QIO shall:

  • ensure that statutorily required functions continue in the event of unexpected downtime occurrences.
  • develop and implement alternate processes and procedures during planned and unplanned downtime events to minimize operational impact.
  • participate in system testing, on-boarding and human-centered design activities as requested by CMS to ensure system effectiveness.
  • participate in Train the Trainer trainings on the CMS-designated IT solution and any future enhancements.
  • train and maintain role-based competency of operational staff on the use of the CMS- designated IT solution and any future enhancements.
  • ensure completeness and accuracy of all QIN-QIO-reported data to CMS, which includes checks prior to data entry and routine data reviews to identify errors and ensure data is of highest quality and available for contractors and CMS staff.
  • proactively monitor and employ quality control activities while keeping compliance with all data formatting specifications, submission guidelines and standards provided by CMS.
  • correct any invalid or inaccurate data; and address any data processing issues to avoid future occurrences.
  • share best practices, learnings, and insights with CMS and other contractors
  • engage with CMS and our support contractors via office hours, training calls and meetings regarding system functionality, data capture, data standardization, reporting and transmission.
  • provide supporting documentation and ad hoc data to CMS upon request…

Read more here.

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