DRAFT MICHIGAN S PROPOSED NURSING FACILITY TRANSITION (NFT) PROGRAM Stakeholder Feedback Session

Transcription

1 DRAFT MICHIGAN S PROPOSED NURSING FACILITY TRANSITION (NFT) PROGRAM Stakeholder Feedback Session

2 DRAFT MICHIGAN S PROCESS IMPROVEMENT INITIATIVE TO RE-DESIGN THE NFT PROGRAM 2 Welcome!!!! At this session we will cover: Why a re-design was needed How initial input was sought Action Team process improvement progress New idealized NFT process Recommendations to eliminate identified barriers Getting your input about other potential barriers and additional ideas for improvement First-round Action Team pilots to test improvement ideas Future stakeholder input sessions please sign up to be invited

3 DRAFT WHY WAS A RE-DESIGN OF NFT NEEDED? Providers felt that the program needed to be more consumer focused and directed. Federal Money Follows the Person funding is ending on October 1, The State is obligated to uphold Olmstead requirements. NFT is an important program and sustainable funding must be found to continue it. Federal and State Requirements were cumbersome. NFT is Michigan s Only Rebalancing Effort. 3

4 DRAFT WHY WAS A RE-DESIGN OF NFT NEEDED Value Stream Mapping of three different sets of duties for providing the current program included: Outreach Specialist Process Steps - 66 Identified Barriers/Delays Ideas for Improvement Transition Coordinators Process Steps - 44 Identified Barriers/Delays - 64 Ideas for Improvement 69 Housing Coordinators Process Steps - 51 Identified Barriers/Delays - 91 Ideas for Improvement 68 4

5 DRAFT NFT RE-DESIGN NEEDED (CONT) Total for the Entire Transition Process Process steps 161 Identified Barriers/Delays 265 Ideas for Improvement

6 DRAFT HOW INITIAL INPUT WAS SOUGHT Value Stream Maps Subject Matter Experts (Now Action Team Members) We asked the question: What would you like to see in a new NFT program? Among those we consulted, were: Medicaid Quality Collaborative Consumers and Providers CIL/DN Directors Waiver Directors ILS/HH Design Team NFT Design Team (state level) PACE Directors NFT Outreach, Transition and Housing Specialists Leading Age Reviewed State NFT programs in California, Connecticut and Ohio 6

7 State Level NFT Design and Action Teams NFT Design Team Mary Ablan Rod Auton Brian Barrie Dave Bulkowski Linda Burqhardt Sarah Cagney Elizabeth Gallagher John Grib Sara Grivetti Lisa Hansen Wendi Middleton Pre-Transition Action Team Rachel Burdette-Comer Sarah Cagney Laurie Dykstra Robin Mossbarger Jennifer Scally Jeanette Tibstra Transition Implementation Issues Action Team Cynthia Cotter Elizabeth Gallagher Tracy James Mary Lockhart Gail Wejrowski Dee Wilkinson Elizabeth Gallagher Post Transition Experience Action Team Martha Anderson Weylin Douglas Gayle Haven Victoria Humble Kathy McGeathy Policy Collaboration Action Team Cheryl Decker Laurie Ehrhardt Lisa Hansen Karen Leppek Melissa Machac Angela Westbrook 7 * A list of Design Team member affiliations is available on Page 19

8 DRAFT NFT VALUES AND RECOMMENDATIONS Nursing Facility Transition (NFT) Program Re-Design Values 8 The program must: 1. Be based on providing a continually better customer experience for people who are transitioning. a. Recommendation: Build in continual quality improvement. b. Recommendation: Build in standardized customer feedback process. 2. Be built on a person-centered foundation that promotes maximum personal choice. a. Recommendation: Person Centered Planning will be required by agencies that provide NFT services. b. Recommendation: Partner with Person Centered Planning Design Team to build standardized person centered planning to be required through policy as part of NFT program. c. Recommendation: Transition Coordinators will now be called Transition Navigators. Transition Navigators will provide options counseling on all aspects of transition services where choices are made, so that transitionees have maximum choice.

9 DRAFT NFT VALUES AND RECOMMENDATIONS(CONT.) 3. Design a process, such that participants communicate with only one person, to eliminate confusion. a. Recommendation: The Transition Navigator will be lead contact with consumer during the transition process and will coordinate the core team activities of housing coordinator, service program staff and any other team members needed to plan and carry out a quality transition, according to the person centered plan. b. Recommendation: Transition Navigator will provide post-transition follow-up with the participant, as determined through the person centered plan, to ensure quality transition. 4. Respect the person s right to take risks. a. Recommendation: Person Centered Planning training will focus on recognition and removal of personal biases and the right of the consumer to take risks. 9

10 DRAFT NFT VALUES AND RECOMMENDATIONS(CONT.) Include flexible timelines each person needs their own individual timeline to transition. a. Recommendation: Arbitrary timelines in current policy will be removed to allow individuals the time they need to transition. 6. Respect participants need to try multiple times to transition successfully. a. Recommendation: There are no limits to number of times a person can participate in the NFT process. b. Recommendation: Transition service array will be expanded to include new services needed. c. Recommendation: Add Occupational Therapy (OT) to transition services, at a minimum on the day of transition, to ensure the consumer s new home is configured in a way that allows for maximum mobility, accessibility and successful transition. d. Recommendation: Add bridge services to service array which will be identified and in place beginning the day of transition (such as home help) to ensure that there is no gap in service provision. This will facilitate enrollment in chosen services/programs which cannot be initiated until the person is officially out of the nursing home. e. Recommendation: Arrangements will be made with Home and Community-Based Services (HCBS) services to ensure NFT transitionees are given the highest priority for start of services on day one.

11 DRAFT NFT VALUES AND RECOMMENDATIONS (CONT) 7. Include additional support for the person so that they can be successful in their transition through such efforts as a mentoring program and others. a. Recommendation: Establish and support transition peer mentoring program. Solicit and train previous transitionees to provide support to new transitionees. b. Recommendation: Connect transitionees to social and community activities, to encourage engagement and promote integration back into the community, as determined by preferences in their person centered plan Include well-trained and qualified staff at all levels, using a reimbursable training system for aides, caregivers and Transition Navigators. a. Recommendation: Develop minimum training requirements for Transition Navigators, Housing Coordinators and others involved in transition activities, including service program staff. b. Recommendation: Payment for training of staff and hands-on caregivers will be included in the new service array. c. Recommendation: Online resources for collaboration, cooperation, and sharing will be developed.

12 DRAFT NFT VALUES AND RECOMMENDATIONS (CONT) 9. Respect and trust providers to make good and responsible decisions. a. Recommendation: Eliminate requirement for state approval to initiate transition services and other pre-approvals. Expand acceptable uses of funds to reduce number of potential exception requests. Policy will presume competence of providers and lack of competence/compliance will be handled on a case-by-case basis, as needed, through program audits. 10. Include clear, concise and consistent two-way communication. 12 a. Recommendation: A written protocol for communication between the state and providers will be developed, tested and implemented using a quality improvement process. This will include a feedback loop, put in place to ensure consistent messaging and communication between the state, providers and transitionees. b. Recommendation: Develop the idea of one NFT program state-wide for marketing and materials which would include standardizing assessment tools, evaluations, and forms.

13 DRAFT NFT VALUES AND RECOMMENDATIONS (CONT) 11. Ensure collaboration over competition. a. Recommendation: NFT will become a State Plan service and will no longer belong to the MI Choice waiver program. b. Recommendation: All providers that choose to participate in the new NFT program will be required to perform the newly defined Transition Navigator role, providing the full array of newly defined Transition Navigator duties needed. c. Recommendation: New NFT Transition Navigator duties and responsibilities are in development and will be piloted. d. Recommendation: An operational definition of quality transition will be developed and piloted. e. Recommendation: Centers for Independent Living and Disability Network agencies will be given access to CHAMPS. f. Recommendation: Consumers can choose which organization to provide their Transition Navigator services and which organization will provide in-home services needed in the community. 13

14 DRAFT NFT VALUES AND RECOMMENDATIONS (CONT) 12. Include consensus on operational definitions for terms, data, metrics and measurements. a. Recommendation: Workgroups, including representatives of aging and disability networks, will be established to develop and reach consensus on standardized operational definitions. 13. Include continual, two-way feedback loop into the system. a. Recommendation: Feedback from transition participants to providers and providers to the state will be included in required program requirements. 14

15 DRAFT NFT VALUES AND RECOMMENDATIONS (CONT) 14. Include purposeful reporting. a. Recommendation: Workgroups mentioned above in #12 will also include development of reporting requirements to include customer satisfaction and other data to demonstrate effectiveness, cycle time improvements, cost savings and general benefits of the program to customer health and well-being, among other factors. 15. Be cost-effective and cost-saving overall, with an eye to low administrative costs. a. Recommendation: Purposeful, standardized reporting, standardized operational definitions, quality improvement built into the system and monitoring of measurements of customer satisfaction, will provide data needed to demonstrate cost effectiveness and positive customer satisfaction. 15

16 DRAFT NFT VALUES AND RECOMMENDATIONS (CONT) 16. Build continual quality improvement into the system. a. Recommendation: State level staff and front line subject matters experts implementing the new and improved NFT program will serve with the BOLD Council in an oversight capacity. When barriers arise and improvements are needed, Design/Action Teams, using subject matter experts, will be initiated to identify barriers and ideas for change and improvement over time. 17. Promote rebalancing of funding from institutional to community-based living. a. Recommendation: The improved NFT process will result in an increase more quality transitions. Metrics will be established to measure, over time, the decrease in the number of people living in nursing homes and increase in people choosing to leave the nursing home and who are successfully (per customer definition) living and receiving services in the community, statistically attributable to NFT. 16

17 DRAFT NFT VALUES AND RECOMMENDATIONS (CONT) 18. Create a future where it is as easy to get out of a nursing home as it is to get into one. a. Recommendation: Measurement over time using customer experience and satisfaction data, nursing home admission and discharge data and other variables, will determine when we have achieved the goal of this value. 17

18 PILOT SCHEDULE NFT Pilots Schedule.xlsx PILOT TIMELINE >>>> June 23 to July 17 July 18 to August 17 August 18 to September 17 September 18 to October 1 October 1, 2017 BOLD COUNCIL & DESIGN TEAMS PHASE 1 PILOTS PHASE 2 PILOTS PHASE 3 PILOTS STATE-WIDE PHASE 3 PILOTS STATE-WIDE STATE-WIDE PILOT IMPLEMENTATION SPREAD 1 SPREAD 2 SPREAD 3 NEW PROCESS IMPLEMENTED NFT PRE- TRANSITION ACTION TEAM Combine Outreach and Transition Specialist roles into one "Transition Navigator" Combine Outreach and Transition Specialist roles into one "Transition Navigator" Combine Outreach and Transition Specialist roles into one "Transition Navigator" Combine Outreach and Transition Specialist roles into one "Transition Navigator" Begin Statewide "Transition Navigator" Sarah Cagney PHASE 2 PILOTS STATE-WIDE PHASE 3 PILOTS STATEWIDE STATE-WIDE PHASE 3 PILOTS IMPLEMENTATION IMPLEMENTATION SPREAD 1 SPREAD 2 SPREAD 3 NEW PROCESS IMPLEMENTED NFT IMPLEMENTATION ACTION TEAM PILOT REVISED ASSESSMENT FORM PILOT REVISED ASSESSMENT FORM PILOT REVISED ASSESSMENT FORM PILOT REVISED ASSESSMENT FORM USE REVISED ASSESSMENT FORM Mary Lockhart x224 PILOT HOUSING FORM PILOT HOUSING FORM PILOT HOUSING FORM PILOT HOUSING FORM USE HOUSING FORM PILOT HOME SAFETY EVALUATION PILOT HOME SAFETY EVALUATION PILOT HOME SAFETY EVALUATION USE HOME SAFETY EVALUATION PHASE 2 PILOTS STATE-WIDE PHASE 3 PILOTS STATEWIDE STATE-WIDE PHASE 3 PILOTS IMPLEMENTATION IMPLEMENTATION SPREAD 1 SPREAD 2 SPREAD 3 NEW PROCESS IMPLEMENTED NFT NFT POST TRANSITION IMPLEMENTATION ACTION ACTION TEAM TEAM Pilot OT Occupational Therapist Ridealong Pilot OT Ridealong Pilot OT Ridealong USE OT Ridealong Martha Anderson Pilot Transition Customer Survey Pilot Transition Customer Survey Pilot Transition Customer Survey Pilot Transition Customer Survey USE Transition Customer Survey Pilot Peer Mentoring Group Pilot Peer Mentoring Group USE Peer Mentoring Group PHASE 2 PILOTS PHASE 3 PILOTS STATEWIDE PILOTS STATE-WIDE IMPLEMENTATION SPREAD 1 SPREAD 2 SPREAD 3 NEW PROCESS IMPLEMENTED NFT NFT POST NFT POLICY ACTION TRANSITION IMPLEMENTATION ACTION TEAM ACTION TEAM TEAM Pilot Timeframe for 1st month posttransition Pilot Timeframe for 1st month posttransition Pilot Timeframe for 1st month posttransition Pilot Timeframe for 1st month posttransition USE Timeframe for 1st month posttransition Lisa Hansen x111 PHASE 2 PILOTS PHASE 3 PILOTS STATEWIDE STATE-WIDE PHASE 3 PILOTS IMPLEMENTATION STATE-WIDE STATE-WIDE IMPLEMENTATION PILOT SPREAD 1 SPREAD 2 SPREAD 3 NEW PROCESS IMPLEMENTED NFT NFT POST NFT POLICY ACTION TRANSITION IMPLEMENTATION BOLD COUNCIL TEAM ACTION ACTION TEAM TEAM Wendi Middleton Coach Design Teams Coach Design Coach Design Coach Design Coach Design Teams Teams Teams Teams STATE-WIDE STATE-WIDE PHASE 3 PILOTS STATEWIDE STATE-WIDE PHASE 3 PILOTS PHASE 2 PILOTS IMPLEMENTATION STATE-WIDE PILOT IMPLEMENTATION 18 SPREAD 1 SPREAD 2 SPREAD 3 NEW PROCESS IMPLEMENTED Page 1 of 1

19 19 LIST OF DESIGN/ACTION TEAM MEMBERS State Level NFT Design Team Mary Ablan Consultant, Area Agency on Aging Association of Michigan (AAAAM) Rod Auton Executive Director, PACE Organization Brian Barrie BOLD Council Member, Division Director, Medicaid/LTC, MDHHS Dave Bulkowski Executive Director, Disability Advocates of Kent Country Linda Burqhardt Executive Director, AAAAM Sarah Cagney NFT Mentor Elizabeth Gallagher MI Choice Section Manager, MDHHS John Grib Deputy Director, Senior Services Inc. Sara Grivetti CEO,Disability Network of Michigan Lisa Hansen NFT Mentor Wendi Middleton BOLD Council Coordinator, Division Director, AASA/MDHHS Dick Miles, Medicaid, MDHHS Policy Action Team Cheryl Decker Medicaid/LTC, MDHHS Laurie Ehrhardt A&D Home Care Lisa Hansen Disability Network Southwest Michigan Karen Leppek AAA WM Melissa Machac Disability Network Oakland & Macomb Angela Westbrook Medicaid/LTC, MDHHS Pre-Transition Action Team Rachel Burdette Comer Disability Network Capital Area Sarah Cagney Senior Services Inc. Laurie Dykstra Reliance Community Care Partners Robin K. Mossbarger - Medicaid/LTC, MDHHS Jennifer Scally Region IV AAA Jeanette Tibstra Disability Advocates of Kent County Post Transition Action Team Martha Anderson Area Agency on Aging, Western Michigan (AAA WM) Weylin Douglas Medicaid/LTC, MDHHS Gayle Haven Medicaid/LTC, MDHHS Victoria Humble - Region VII AAA Kathy McGeathy The Disability Network Implementation Action Team Cynthia Cotter Senior Services Inc. Elizabeth Gallagher, Medicaid/LTC, MDHHS Tracey James Region 2 AAA Mary Lockhart Disability Network Mid Michigan Dee Wilkinson AAA of Northwest Michigan Gail Wejrowski The Senior Alliance

20 FUTURE STAKEHOLDER INPUT SESSIONS August 2017 To share results of initial pilots and new or amended recommendations September 2017 To share results of pilots as part of spread plan and new or amended recommendations 20

21 21 THANK YOU!!!