The Medicare Quality Improvement Organization (QIO) Program (formerly referred to as the Medicare Utilization and Quality Control Peer Review Program) was created by statute in 1982 to improve quality and efficiency of services delivered to Medicare beneficiaries and safeguard the integrity of the Medicare trust fund. In the early years, PROs conducted review work to ensure Medicare was paying for medically necessary care. Early quality efforts were limited largely to reviewing individual patient’s care to identify instances in which professional standards were not met, a process known as case review.  In the early 1990s, as a result of recommendations by the Institute of Medicine, Medicare shifted the main focus of the program to proactive community-based quality improvement and beneficiary education.  QIOs now work in partnership throughout the healthcare system to help ensure the right care for every person every time. The program continues to evolve in response to changes in our understanding of how to improve quality as well as the environment to promote public reporting of provider performance and the development of performance-based payment programs.