CMS Pub. 100-16, ch. 5, § 20.1.2

QIPs are initiatives focused on one or more clinical and/or non-clinical areas with the aim of

improving health outcomes and beneficiary satisfaction. Beginning CY 2012, each MAO is

required to conduct, over a 3-year period, a QIP focused on reducing 30-day all cause hospital

readmission rates.

QIP Plan Section Description

The QIP Plan section describes all aspects of the proposed QIP initiative, including, but not

limited to: the opportunity for improvement, target goal, what specific interventions will be

introduced to achieve the identified goal, members targeted for receipt of the intervention(s), and

the expected results. Please note that we expect SNPs to develop interventions that are tailored

to their specific target population. While an organization may choose the same basic

intervention(s) for its SNP and non-SNP plans, we expect the intervention(s) and overall

approach to appropriately address the unique characteristics and needs of the targeted

populations. Below is a general summary of the required components of the QIP Plan.

• Basis for Selection – An overall description of the QIP and rationale for selection that

includes impact on the member, anticipated outcomes, and rationale for selection. (Note:

The QIP Plan Section specific to a SNP may include, if applicable, any Model of Care

elements which form the basis for the QIP, e.g., the Individualized Care Plan, the

Interdisciplinary Care Team, etc.)

• Program Design – An outline of the process used to identify the target population, risk

stratification, and enrollment method.

• Prior Focus – A description of any previous attempts to address the problem that the QIP

will be addressing. This includes intervention-specific information about the previous

attempt(s), including any outcomes achieved.

• Examination of any anticipated barriers and the potential impact on the success of the

QIP.

• Outcome Measures and Interventions - Setting objectives in measurable terms;

identifying the appropriate data source(s) to measure; and the methodology used to

analyze the data to determine whether/how the initiative affected the health status of the

targeted population.

QIP Annual Update Section Description

The QIP Annual Update is due during the CMS-determined submission window in the fall of the

first year of implementation following approval of the QIP Plan Section, and annually thereafter,

until project completion. The Annual Update should include the results or findings to date,

based on the intervention(s); any barriers encountered during the update period; risk mitigation

activities implemented to address barriers encountered; the impact on the established goal or

benchmark, and next steps for the project. Below is a general summary of the components of the

QIP Annual Update.

• Intervention(s) - Specific actions/approaches implemented to achieve the stated goal.

• A description of Barriers encountered, if applicable, and the specific actions taken to

mitigate those barriers.

• Discussion of findings and analysis of results to date in relation to the established goal,

benchmark, timeframe, total population, numerator, denominator, results and other data

results. Identification of Next Steps based on internal evaluation and ongoing assessment

of the QIP, whether or not the goals were met, and any revisions to the intervention(s),

methodology, goal, or other aspects of the initiative.

• Best Practices - Any identified approaches that are proven to be reliable and appear to

contribute to the success of the QIP.

• Lessons Learned - Description of pertinent knowledge gained through the QIP

experience.