What does quality improvement actually mean? And how does it improve the care patients receive? Dr. Russell Cole, family physician and chief medical officer of TMF Health Quality Institute, recently appeared on AFMC TV to discuss quality improvement and why it is important for Arkansas and other rural states.
Who is TMF, and what do they do?
In 2014, the Centers for Medicaid and Medicare Services (CMS) implemented Quality Improvement Network-Quality Improvement Organizations (QIN-QIOs) as part of the Medicare program. The program is generally a three to five-year contract focused on quality improvement for anyone who bills Medicare. The QIN-QIO structure is currently in its 13th iteration, known as the 13th scope of work. TMF Health Quality Institute is the QIN-QIO for Arkansas, Missouri, Oklahoma, Texas, and Puerto Rico.
“This is a free program to any healthcare provider who bills Medicare,” Dr. Cole says. “This is a program…focused on how we make measurable improvements.”
TMF is focused on rural and small providers in Arkansas, aiming to reduce burnout and workforce shortages across the entire healthcare system. The idea is to evaluate the workforce needs of all healthcare staff and use data to improve the quality of care performed at these locations.
“We collect lots of information, but are we actually turning it into something that helps us make better decisions about how to take care of folks?” Dr. Cole asks.
TMF partners with local organizations like AFMC to help drive better outcomes, better care, and better systems for providers and their patients. Dr. Cole says some of the main focuses are on diabetes and heart disease, and on ensuring that these conditions are identified as early as possible and that patients receive the right care.
AFMC has been a great partner for years, and we really appreciate the great work that you're doing in Arkansas. We hope to continue a long and happy relationship of helping folks across the region get better care.”
“If the doctor gives you medicine, but it takes nine months to make things better, [we evaluate how] we could have made that better in three months by recognizing it’s not working, making an adjustment, and getting your medications corrected that way.”
Improving rural health in Arkansas is a priority.
Arkansas is a rural state with several healthcare challenges. Patients in rural areas often visit the emergency department because they lack access to care in their communities. TMF focuses on ensuring patients receive the right level of care at the right time to reduce unnecessary emergency room visits.
“We want to make sure your care is coordinated and reliable and that you don’t have to know a secret handshake to have the continuity of care folks actually need.”
One of the most compelling aspects of this Medicare program is its focus on practical changes that address real-world situations. This isn’t a far-removed executive in D.C. trying to fit a square peg in a round hole. This is local technical assistance from experts who live in Arkansas, know the communities, and understand the nuances of different patient populations across the region.
“Recognizing and understanding the differences from community to community helps ensure that the assistance we provide to folks is tailored to the type of practices they actually have,” Dr. Cole says.
New partnerships help further quality improvement efforts.
TMF recently announced partnerships with organizations such as the Institute for Healthcare Improvement and Arrow ARC to expand its impact across the state. Dr. Cole says the focus of these partnerships is to call upon the expertise of organizations that already do great work instead of trying to reinvent the wheel.
“IHI is an internationally known agency that does a great job of providing basic education for the community on improving healthcare,” he says. “We could provide this education ourselves, or we could create a partnership that allows us to link IHI with the participating hospitals, nursing homes, and physician offices so they can have access to all of IHI’s training programs.”
IHI’s quality improvement training course is roughly equivalent to a master’s degree in quality improvement. Many small communities don’t have the funds to send someone to school, but TMF helps make these opportunities available through this partnership with IHI at no cost to providers.
“Arrow ARC has a long history of working with the Veterans Health Administration around staffing for their facilities, hospitals, and nursing home programs,” Dr. Cole says. “Staffing is a big issue for Arkansas practices, and you can’t talk about how to improve healthcare quality if you don’t have the staff to pull it off.”
Arrow ARC will bring its decades of experience with staff recruitment, training, and retention to Arkansas practices as jobs come open within the community. These are resources that rural practices normally don’t have access to. Calling upon the expertise of established organizations to further improve healthcare quality in Arkansas will be a true value add for many practices. 
How can this model help improve healthcare access nationwide?
TMF’s work in Arkansas and other rural states helps larger providers across the nation recognize that a rural state can lead the way in practical quality improvement.
“A lot of times when people talk about quality of care, they want to talk about the Mayo Clinic or Massachusetts General,” Dr. Cole says. “Well, you can have those same sorts of experiences in a rural state like Arkansas, too, thanks to strong community partnerships.”
QIN-QIOs are designed to identify and improve access to care across the entire patient journey—understanding where patients can go for primary care, specialty care, and emergencies. These are not things Arkansas and other rural states have had to think about for generations. The holistic, community-based approach to care translates well to other, larger health systems.
QIN-QIOs improve prevention and chronic disease management.
TMF improves prevention and chronic disease management in two ways.
The first is with data. “Sometimes, you have a whole lot of information in an EHR that may not actually get looked at or used to generate reports,” Dr. Cole says. “Sometimes, physician offices are so busy trying to deal with the problem in front of them that they don’t get to think about the problems down the road.”
To facilitate greater focus on prevention, TMF is working to automate processes for identifying immediate and long-term patient needs so that providers can better prepare for preventive care visits that may be needed in the near future.
The second way TMF is working to improve prevention and chronic disease management is through technology integration.
“Medicine changes incredibly rapidly, and AI has not done anything to slow down that change,” Dr. Cole says.
TMF is working to help physician practices, hospitals, and nursing homes integrate AI into their care so providers have the information they need to make better-informed decisions.
“The days of waiting until the New England Journal of Medicine is published to know what changes are occurring in medicine are a thing of the past,” he adds. “So we’re trying to keep up with the technological advancements while also allowing physicians to have more time to see their kid play baseball one evening or to have dinner with the family instead of sitting under a pile of medical journals all afternoon.”
Why are health data and personalized care key to quality improvement?
It’s rare these days for a patient to receive all the care they need in one place. As patients move through different parts of the healthcare system, it’s important that their data follows them. Interoperability helps ensure that specialists, primary care physicians, and hospital staff know what patients were seen for previously and what information may be relevant to their current care needs.
“We want to make sure that patient data is being shared among all of these points, not because we’re just trying to move from point A to point B, but because we’re trying to ensure that patients receive the best care possible,” Dr. Cole says.
TMF ensures patients receive the best possible care, regardless of their situation. By focusing on local barriers and community needs, they work to ensure health care is working best for all people.
How will quality improvement change in the future?
What will quality improvement look like in five years? Dr. Cole says it will look a lot like it did before, but with more awareness of patients’ needs.
“Remember a time when your doctor actually knew what was going on around your life? The care was connected when you went from place,” he says. “There were no dropped handoffs. If you left the hospital, your doctor knew you had been there and what needed to be done. You didn’t feel like you had to be the sole person getting you through the healthcare system.”
Five years from now, Dr. Cole hopes healthcare looks more like that. This means ensuring that information moves and that patient data is used to improve care. By helping patients, we’re also assisting physicians. Removing administrative burdens helps them go home in the evening, spend time with their families, and have dinner.
Providers won’t have to stare at a screen throughout their visit. Instead, they can put a hand on a patient’s shoulder, talk to them, and give them the full spectrum of care that they need, not just the medical interventions they need.”
