Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Continuous Quality Improvement (CQI) Model


CMS’s evidenced-based approach, while new to the Medicaid HCBS enterprise, is based on a well-established management tool known as Continuous Quality Improvement--or CQI. The CQI concept is generally credited to W. Edwards Deming, a statistician who pioneered this approach in his work with manufacturers in Japan in the late 1940s. At the heart of the CQI model is the use of empirical information--that is, evidence--to drive continuous, cyclical improvement. CMS has embodied the CQI principles in its Design, Discovery, Remediation, Improvement (DDRI) model. The DDRI model has been the operative framework for HCBS waivers since the early 2000s and is the common vocabulary that links CMS’s expectations and state quality efforts. CQI is best envisioned as a cyclical process, one component feeding into the next.

FIGURE 1. The DDRI Model
Organizational Chart: Improvement leads to Design, which leads to Discovery, which leads to Remediation, which leads back to Improvement.

It is CMS’s expectation that Medicaid HCBS programs embrace the CQI approach and nurture a culture of quality improvement.

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