Nationally, the Centers for Medicare & Medicaid Services (CMS) sought to improve care provided to patients with ESRD who were being treated in outpatient dialysis facilities. The ESRD Quality Incentive Program was the first of its kind in Medicare. It linked a portion of facilities’ payments directly to their performance on specific NQF-endorsed quality of care measures. The initiative was fully launched in 2012, and within its first two years, the majority of dialysis facilities significantly improved on three clinical process measures related to dialysis adequacy and anemia management. Better performance in these areas, and early fistula placement, are tightly linked to important ESRD patient outcomes, including reduced hospitalizations and fewer deaths across the country.

Locally, quality initiatives are making strides to improve care for patients with diabetes. At the Carolinas Medical Center, ongoing diabetes management education of medical, nursing, and dietary staff coupled with a multidisciplinary steering committee guiding its diabetes care improvement process resulted in 4,000 fewer hospitalizations for patients with diabetes between 2008 and 2009.

At HealthPartners in Minnesota, long-time efforts have reduced the long-term effects of diabetes. HealthPartners data comparing 32,000 members with diabetes in 2011 versus 2000 showed fewer heart attacks, leg amputations, and eye complications.