The file's text, extracted by GovTribe without its formatting.
Appendix 10 13th SOW Terminology
Name (Alphabetical by first letter)
| Acronym or Abbreviation |
| Definition, Purpose, or Vision |
| 13th Scope of Work |
| 13th SoW |
| The 13th SoW is the sum of Quality Improvement Programs that will be executed from FY2024 – FY2029. The Scope includes the various programs and their associated contracts (Statements of Work) in pursuit of CMS’ quality improvement goals and priorities. |
| 13th Statement of Work |
| 13th SOW |
| The Statement of Work refers to a specific body of work under the larger Scope of Work. The SOW encompasses the base Contract, task orders, background, requirements, schedule of deliverables, measures, and appendices associated with the contract. |
| Advancing Health Care Quality through Technology |
| AHQT |
| As one of two foundational Aims in the 13th SoW, the goal of AHQT is to improve the readiness of providers for, data exchange, which is a building block to access, share, and use data for quality improvement purposes. |
| Advancing Health Care Quality through Technology Readiness Assessment |
| AHQT Readiness Assessment |
| Assessment conducted by the QIN-QIOs that uses a mix of foundational, technical, administrative, and operational questions to assess a provider or clinician’s readiness to transition systems and infrastructure to access, share and use data for quality improvement. The assessment will help determine the providers’ readiness for AHQT, and the appropriate evidence-based interventions and technical assistance that could be provided by the QIN-QIO. |
| Advancing Health Care Quality through Technology Tier |
| AHQT Tier |
| A tiered system to identify a provider’s readiness for AHQT. The tiers range from Tier 0 – Tier 3 based on the results of the readiness assessment. |
· Tier 0: Providers in this tier face environmental constraints that limit the adoption of technology solutions.
· Tier 1: Providers in this tier are at the lowest level of technical readiness and will require a significant level of support to optimize their Health IT infrastructure to access, share, and integrate data for quality improvement purposes.
· Tier 2: Providers in this tier are exchanging information with internal and external entities and utilize an EHR system that has the technical capabilities required by the Promoting Interoperability (PI) program (attesting to PI not required).
· Tier 3: Providers in this tier have demonstrated use of technical capabilities that comply with the most recent Office of the National Coordinator for Health IT (ONC)-certification criteria for Health IT [including the use of Fast Healthcare Interoperability Resources (FHIR®) Application Programming Interfaces (APIs)] as well as the PI program (attesting to PI not required).
| Aims |
| Aims |
| Goals identified for the quality improvement program. There are 2 types of Aims in the QIN-QIO 13th SoW: Foundational Aims and Clinical Aims. They are determined by CMS. Both categories of aims provide a clear and firm intention to improve quality and are in place to guide and organize efforts for success of the program. |
American Indian Alaska Native Quality Improvement Program
| AIANQI Program |
| CMS’ Quality Improvement Program focused on achieving quality goals in the American Indian Alaska Native population. |
| Application Programming Interface |
| API |
| A type of software interface that connects computers or software to each other. It is used to send information between two or more computers. |
| Assess – Coordinate / Complement / Create Model |
| A3C Model, or A3C |
| A3C (Assessment/Coordinate/Complement/Create) Model is a unique CMS-developed framework for QIO service driven by value. It requires the QIO to first assess through completion of an environmental scan at the state level, to obtain an understanding of the healthcare landscape, the interested partners, and the quality initiatives related to their planned work. Based on this assessment, the QIO will then determine their unique role in filling any identified gaps and improving quality. The information and data gathered from the assessment will be used to inform a meaningful and uniquely curated QIO role (Coordinating existing efforts, Complementing initiatives, or Creating initiatives) that avoids duplication of services and relieves burden on providers. |
| Centers for Medicare & Medicaid Services |
| CMS |
| As part of the Department of Health & Human Services, CMS is the federal agency that provides health coverage to more than 100 million through Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace. CMS works in partnership with the entire health care community to improve quality, equity, and outcomes in the health care system. |
| Beneficiary and Family Centered Care – Quality Improvement Organization |
| BFCC-QIO |
| The Beneficiary and Family Centered Care - Quality Improvement Organizations that help beneficiaries with concerns about the quality of care they receive from their Medicare provider. The BFCC - QIOs review complaints and quality of care, and help to improve the effectiveness, efficiency, economy, and quality of services provided to people with Medicare. They also support appeals determinations when concerns are brought forward related to discharge to a lower level of care and/or home environment. |
| Center for Clinical Standards and Quality |
| CCSQ |
| As part of CMS, CCSQ serves as the focal point for all quality, clinical, medical science issues, survey and certification, and policies for CMS' programs. |
| Clinical Aim |
| Clinical Aim |
| The Clinical Aim has a direct focus on clinical and health outcomes. Clinical Aims are organized by general focus areas. For the 13th SoW, there are 4 Clinical Aims: Behavioral Health, Prevention and Chronic Disease Management, Patient Safety and Care Coordination. |
| CMS Quality Conference |
| CMS Qual-Con |
| This is the nation’s premier health care quality conference. The annual conference, organized and hosted by the CMS Quality Improvement & Innovation Group, drives national conversation across a broad range of health care quality topics, such as patient safety, health care system resiliency, health equity, and more. |
| Contractor Performance Assessment and Reporting System |
| CPARS |
| Facilitates reporting and rating of contractor performance. Objectives are to: |
· Support best value source selection decisions; and
· Provide up-to-date and accurate documentation of the contractor’s ability to meet requirements.
| Electronic Health Record |
| EHR |
| This is an electronic version of a patient’s medical history that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports The EHR automates access to information and has the potential to streamline the clinician's workflow. The EHR can also support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting. |
| Emergency Preparedness |
| EP |
| One of two foundational Aims in the QIN-QIO 13th SOW. This aim promotes adoption of planning and preparedness to safeguard the public as well as healthcare and public health personnel. |
| End Stage Renal Disease (ESRD) Network |
| ESRD NW |
| Under contract with CMS, there are 18 ESRD Network Organizations that focus on promoting the health care for all ESRD patients, to ensure care is safe, effective, efficient, patient-centered, timely and equitable. |
| Executive Leadership Council |
| ELC |
| The QIO Executive Leadership Council consists of the C-Suite leadership of the QIN-QIO and senior community partners and leaders, and is fully accountable for engagement, collaboration and QI outcomes in a particular Region. Each QIO Region will have its own ELC. |
| Fast Healthcare Interoperability Resource |
| FHIR |
| The standard that defines how healthcare information can be exchanged between different computer systems regardless of how it is stored in those system. The goal of FHIR is to enable the seamless and secure exchange of health care information. |
| Focused QIO Service |
| FQS |
| Highly targeted form of QIN QIO assistance to facilities identified by CMS for a uniquely customized approach to a quality, safety or other concern determined by CMS as requiring time-limited, swift, Quality Improvement Intervention. |
| Foundational Aim |
| Foundational Aim |
| Is a non-clinical, fundamental, necessary, and basic building block as part of the strong quality infrastructure upon which further improvements can be achieved. For the QIN-QIO 13th SoW, quality management infrastructure, emergency preparedness and the effective use of technology are foundational elements of a strong quality organization. |
| Health and Human Services Regions |
| HHS Regions |
| The mission of the U.S. Department of Health and Human Services (HHS) is to enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services. |
| Health Information Technology |
| HIT |
| Health information technology (health IT) involves the processing, storage, and exchange of health information in an electronic environment. Widespread use of health IT within the health care industry will improve the quality of health care, prevent medical errors, reduce health care costs, increase administrative efficiencies, decrease paperwork, and expand access to affordable health care. |
| Interventional Design Framework |
| IDF |
| This is a CMS-designed framework that outlines the specific evidence-based, proven best practices and quality improvement interventions that are likely to provide a high likelihood of success in meeting the quality goals for each Aim. CMS has prescribed interventions, with the QIN QIOs being able to add others based on unique facility needs. |
The interventions are categorized under 5 key disciplines:
· Governance
· System design and policies
· Process
· Workforce
· Individuals, Families, and Communities
| Merit-Based Incentive Payment Systems |
| MIPS |
| The CMS Quality Payment Program for collecting and reporting data cross 4 areas: quality, improvement activities, Promoting Interoperability, and cost. MIPS was designed to tie payments to quality and cost-efficient care, drive improvement in care processes and health outcomes, increase the use of healthcare information, and reduce the cost of care. |
| National Coordinator for Health IT |
| ONC |
| The principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. |
| National Learning and Communication Contractor |
| NLC |
| Anticipated, planned contract to support QIN-QIOs in the 13th SoW. The NLC contractor will manage all collaboration, learning and communication activities for iQIIG’s NQIIC Task Orders including the QIN-QIO. The contractor will coordinate and maintain training resources for providers and beneficiaries and will facilitate communication between and to all QIN-QIOs so as to unify messaging and deliver communications and training in a consistent manner. |
| Network of Quality Improvement and Innovation Contractors |
| NQIIC |
| NQIIC is an indefinite delivery/indefinite quantity contract to support CMS quality improvement efforts across settings and programs to maximize impact to healthcare and value to taxpayers. NQIICs are defined as a set of quality improvement contractors that have the capability to achieve large scale improvement results using effective and innovative quality improvement strategies that are data driven, transparent, and empower patients, families, and clinicians to make decisions about their healthcare. Anticipated contracts under the NQIIC in the 13th SOW includes QIN-QIO work, the ESRD Network work, American Indian Alaskan Native Quality Program, and other quality improvement work. |
| On-boarding |
| None |
| The process of integrating new employees into the QIN-QIO and familiarizing stakeholders with CMS/QIN-QIO quality improvement services. The QIN-QIO shall complete on-boarding of staff that will support and work for the 13th SoW based on the personnel requirements set forth in the statement of work. |
The journey map illustrates the implementation plan for the QIN-QIO program from contract start date to end date:
· Year 1:
QIN-QIO On-boarding
· Stakeholder Engagement
· State- Level A3C Assessment
· Provider Service Agreement
· Initiative Quality Action Plan Development
· Years 2 – 4:
QI Cycle
· Hands on QI Work
· Outcomes Reporting
· Reassessment
· Performance Evaluation
| Period of Performance |
| PoP |
| The Period of Performance (PoP) is the total amount of time that CMS authorizes the contractor to complete the work outlined in the statement of work. |
| Program Monitoring and Evaluation Contractor |
| PMEC |
| Anticipated and planned to support QIN-QIOs in the 13th SoW, this contract will conduct ongoing program monitoring and objective evaluation of the impact of the 13th Scope of Work (SOW) contracts: American Indian Alaska Native Quality Program, Beneficiary and Family Center Care (BFCC-QIO), Quality Innovation Network (QIN-QIO), and SUPPORT Act Opioid work. |
| Promoting Interoperability |
| None |
| Providers demonstrate they're using certified Electronic Health Record (EHR) technology in ways that can be measured against quality standards. These standards allow eligible providers to earn incentive payments by meeting specific criteria. |
| Provider Assessment |
| None |
| Assessment conducted by the QIN-QIO of individual provider needs to identify interventions to be deployed in order to support quality improvement. |
| Provider Service Agreement |
| PSA |
| A written agreement between a QIN-QIO and a provider in which they mutually agree upon which quality improvement services the QIN-QIO will deliver to the provider, and the responsibilities of both. The PSA will facilitate cooperation and sustained participation in the QI work while ensuring the understanding of expectations and value. |
| QIO Connect |
| None |
| Collaboration portal to allow QIOs to interact with other QIOs, PMEC, NLC and CMS. |
The portal will include the following key feature categories:
· Organized Content: Store, organize, share and access resources, best practices, success stories and insights.
· Timely communication: up to date on new information, requirements, deadlines and announcements, all in one central platform provided by CMS with ability to send via system to all contractors.
· Communication/Learning Environment: interactive forums to learn and share lessons with each other. Sharing aggregated data routinely.
· Empower Initiative in Leading Discussions: QIOs can create their own communities and solutions based on specific target/subject areas.
· Advanced Planning: access to a shared calendar with events and trainings.
QIO Connect will not include information or discussions related to:
· Contract Management
· Technical Direction to the Contractor
· Sensitive information such as PII/PHI
· Issues related to QIO performance and/or funding
| Quality Action Plan |
| QAP |
| Unique to each provider, The QIO drafts the QAP based on the provider assessment conducted by the QIN-QIO and the state-level A3C model. The QAP should define areas of focus to support quality improvement. |
| Quality Improvement |
| QI |
| Quality improvement is the framework used to systematically improve care. Quality improvement seeks to standardize processes and structure to reduce variation, achieve predictable results, and improve outcomes for patients, healthcare systems, and organizations. |
| Quality Improvement & Innovation Group |
| QIIG |
| As part of CCSQ, QIIG comprises and manages the Agency’s extensive quality improvement and innovation portfolio, with the mission of improving healthcare quality and safety through beneficiary and provider assistance programs. |
| Quality Improvement Organization |
| QIO |
| A Quality Improvement Organization (QIO) is a group of health quality experts, clinicians, and consumers organized to improve the quality of care delivered to people with Medicare. There are two types of QIOs that work under the direction of the CMS in support of the QIO Program: |
· Beneficiary and Family Centered Care BFCC-QIOs
· Quality Innovation Network QIN-QIOs
| Quality Innovation Network – Quality Improvement Organization |
| QIN-QIO |
| The Quality Improvement Network – Quality Improvement Organizations bring Medicare beneficiaries, providers, and communities together in data-driven initiatives that improve patient safety, make communities healthier, better coordinate post-hospital care, and increase clinical quality. QIN-QIOs are skilled in creating opportunities for providers to learn from each other, applying advanced improvement and analytical methods, engaging patients and families, and structuring processes for sustaining positive change. |
| Quality Management Infrastructure |
| None |
| One of two Foundational Aims in the QIN-QIO 13th SoW. This Aim supports the administration of systems design, policies and processes that minimize, if not eliminate, harm while optimizing patient care and outcomes. |
| Readiness Assessment |
| None |
| Qualitative assessments performed by the Program Evaluation and Monitoring (PMEC) contract to evaluate data reporting elements such as QIN-QIO dashboards, success stories, accuracy of submitted provider data. |
| Region |
| None |
| A group of states that is serviced by a QIN-QIO. For the QIN-QIO 13th SOW, CMS aligned service areas with established HHS Regions, to provide for an equitable balance of providers and beneficiaries while providing an integrated model for QIO work and establishing the QIO as a single point of accountability for that Region. |
| Rural Emergency Hospitals |
| REH |
| Medicare provider designation established by Congress through the Consolidated Appropriations Act of 2021. REHs are meant to reinforce access to outpatient medical services and reduce health disparities in areas that may not be able to sustain a full-service hospital. Starting January 2023, Critical Access Hospital (CAHs) and small rural hospitals with no more than 50 beds may apply for REH designation and receive Medicare payment for providing emergency services. |
| Rural Populations |
| None |
| Rural Populations consists of any individual that lives in rural areas or primary flow to a tract outside of an urban area or an urban commuting area. |
| Servicing Provider List |
| SPL |
| A list of providers CMS has identified for the QIOs to work with for the purpose of 13th SoW quality improvement, based on specific criteria. |
| Sub-aim |
| Sub-aim |
| Under each Clinical Aim, there are a series of sub-aims that are specific focus areas within that Clinical Aim. The Sub-aims serve as goals that further define and specify the work to be performed under the Clinical Aims that will directly lead to better clinical outcomes. There are 13 Sub-aims identified for the QIN-QIO 13th SOW. |
| Task |
| None |
| A broad description of a healthcare quality improvement focus area, collection of specific activities, and performance requirements. |
| Task Order |
| None |
| According to the Federal Acquisition Regulation, a “Task order” means an order for services placed against an established contract or with Government sources. |
| Technical Assistance |
| TA |
| Technical assistance is the use of specialized expertise in providing hands-on assistance, coaching, information, tools, training and consultancy to individuals or groups who need help in an area in order to move to the next level of performance. Technical assistance may take many forms depending on the nature of the need. A needs assessment, root cause analysis, or review of data is often conducted to determine the nature of the needed assistance. |