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IFMC Health Care Quality Programs

Iowa Foundation for Medical Care (IFMC) Health Care Quality Programs is a leader in innovative solutions impacting health care quality. The company has pulled together teams of health care professionals, quality improvement specialists, statisticians, communicators and others to create new and better ways to:

  • Capture, manage and report quality improvement data
  • Develop and disseminate quality improvement programs, tools and general information
  • Provide oversight for health care quality concerns
  • Be an agent for change management

Federally Designated Quality Improvement Organization

Under contract with the Centers for Medicare & Medicaid Services (CMS), IFMC has been Iowa's Quality Improvement Organization (QIO) for over 30 years. IFMC serves more than 500,000 Medicare consumers and the health care community in the state by facilitating transformational change within the care system. In this effort, we are guided by the principles outlined by the Institute of Medicine: Care will be safe, effective, patient-centered, timely, efficient and equitable to all beneficiaries that Medicare serves.

QIOs collaborate with consumers and health care providers to foster an environment in which every person receives the right care every time by:

  • Helping physician offices, hospitals, nursing homes and home health agencies create patient-centered structures focused on a culture of quality
  • Improving the use of proven tools and processes to increase efficiency and effectiveness of care delivery
  • Enabling health care providers to use information technology to support patient care
  • Measuring performance to track progress and identify opportunities for improvement
  • Providing beneficiary case review services, including quality of care complaints through medical record review and mediation

State of Iowa Medicaid Enterprise

As a major partner in the Iowa Medicaid Enterprise program, IFMC is helping pioneer new roads for Medicaid. IFMC is one of only a few key vendors working with the State of Iowa Department of Human Services (DHS) to build an integrated Medicaid Enterprise. The program is designed to transform Iowa Medicaid from a payer of health care claims to a prudent purchaser of health care services. Under this integrated approach, cost efficiencies are being attained not only through management of utilization, claims and revenue, but also through improving quality of care and outcomes. Utilizing our 25-year relationship with Iowa DHS as a basis for success, IFMC’s role in the Iowa Medicaid Enterprise includes:

  • Long Term Care Assessment
  • Medical Prior Authorization (PA)
  • Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
  • Targeted Case Management (TCM)
  • Medical Support
  • Disease Management
  • Enhance Primary Care Case Management (EPCCM)
  • Preferred Drug List (PDL), Drug Utilization Review (DUR) and Pharmacy Prior Authorization

CMS Special Projects

IFMC maintains an ongoing quality improvement leadership role for CMS through projects including:

  • Developing and testing an expanded set of clinical measures for physician offices (Doctors’ Office Quality or DOQ project)
  • Providing technical support to the national program for public reporting of hospital performance data (Hospital Reporting Program Quality Improvement Organization Support Center or HRP QIOSC)
  • Developing and operating a national QIO Continuing Medical Education (CME) program for providers engaged in quality improvement work
  • Providing knowledge, technical support and auditing services of DOQ quality of care measures in the Physician Group Practice (PGP) pay-for-performance demonstration project
  • Performing national evaluation of accreditation audits for Diabetes Self Management Training (DSMT) providers

Other Special Projects

In addition to projects for CMS, IFMC is involved in many other health care quality improvement special projects, including:

  • American Medical Association: IFMC provides technical assistance for the development and testing of new clinical performance measures.
  • Iowa Department of Insurance: Since 1985, IFMC has performed external review of commercial managed care plans licensed in the state.
  • Iowa Society of Thoracic Surgeons: IFMC conducts retrospective audits of the society’s statewide clinical database and other tasks in support of the society’s quality improvement goals.

For more information on IFMC Health Care Quality Programs, visit www.internetifmc.com or call Mike Speight at 1-800-383-2856, ext. 8251.