Adult Medicaid Quality Grants: Where Are We Now?

Transcription

1 Adult Medicaid Quality Grants: Where Are We Now? Facilitated By: Virginia (Gigi) Raney Project Officer, Adult Medicaid Quality Grants and Health Insurance Specialist, CMCS Kamala Allen Director, Child Health Quality, Center for Health Care Strategies The CMS Healthcare Quality Conference Baltimore, MD December 2 4, 2014 Follow us on Tweet with our conference hashtag: #QualityNet14

2 Agenda Adult Medicaid Quality Grantee Introductions Sharing Lessons Learned from Adult Medicaid Quality Grantees Gigi Raney and Deirdra Stockmann Assessment of the Adult Quality Measures Grant Program Pamela Spain 2

3 Sharing Lessons Learned from Adult Medicaid Quality Grantees Gigi Raney Project Officer, Adult Medicaid Quality Grants and Health Insurance Specialist, CMCS Deirdra Stockmann Health Insurance Specialist, CMCS

4 Themes Theme 1: Key Partnerships Internal and external Theme 2: Staff Capacity and Infrastructure Theme 3: Data Collection and Analytics Theme 4: Quality Improvement Projects Successes and challenges Theme 5: Promising Practices Quality measurement Quality improvement Diffusion strategies 4

5 5 Theme 1: Key Partnerships

6 Internal Partnerships Leadership support is crucial Expand partnerships beyond Medicaid to other state Health and Human Services (HHS) agencies Create cross-project synergies Align with other quality improvement efforts Lessons learned Additional time is required when working with multiple stakeholders Bring all partner agencies on board in the beginning 6

7 External Partnerships Partnerships with providers are essential Providers offered key insights Knowledge of how to address challenges among subpopulations Understanding of usefulness and clinical significance of measures Identification of issues facing front-line providers and ensuring appropriate solutions Site visits proved invaluable Lessons learned Resources are limited Coordination takes time 7

8 8 Theme 2: Staff Capacity and Infrastructure

9 Building Internal Staff Capacity States focused on capacity building in key areas Hiring new staff Data analysis and reporting capabilities Quality improvement training Planning current and future Quality Improvement Projects (QIPs) Lessons learned Hiring always takes longer than anticipated! Local variation 9

10 Developing Infrastructure Grant funding was critical for: Purchasing needed equipment Building capacity in existing analytics vendor systems Engaging grant evaluation team during design phase Ensuring collection of key data Lessons learned Contracting always takes longer than anticipated! Resolving contract/legal issues is a necessary part of start-up 10

11 11 Theme 3: Data Collection and Analytics

12 Data Collection Common challenges: Updating systems for new specifications Healthcare Effectiveness Data and Information Set (HEDIS) software may not adhere to specifications Implementing specifications for non-hedis measures Data system limitations or lack of data access made it difficult to report measures for certain populations Lessons learned: Providers methods for collecting data vary Linking vital records and Medicaid claims data is a priority Local codes may be required for measuring utilization Examine differences between rates calculated from claims and electronic health records 12

13 Data Analytics Strong validation processes are essential Need data management plans and documentation Stratification by sub-populations is valuable Identify data issues early on Allow for analysis of disparities Small sample size is a challenge Work with fiscal staff to improve and standardize administrative claims Align and standardize systems, methods and strategies across delivery systems 13

14 Theme 4: Quality Improvement Projects (QIPs) 14

15 QIPs: Successes Innovative models benefitted providers and enrollees Built partnerships Data analysis led to targeted improvement strategies Health workers, navigators, and community members helped enrollees overcome barriers to accessing services Tested incentives to drive better health outcomes Plan-Do-Study-Act cycles supported measurement and accountability 15

16 QIPs: Challenges Quality improvement takes time Collaboration Data analysis Provider engagement and buy-in Patient engagement and enrollment Interim and process measurement Integrating data systems Behavioral and physical health Funding Applying results to diverse populations 16

17 17 Theme 5: Promising Practices

18 Promising Practices: Quality Measurement Use baseline results to analyze population differences Use other systems to improve data completeness Collect and use additional data to drive improvements Expand reporting of Adult measures and report more complete Child measures Use CAHPS data to expand measurement and reporting Develop systems to streamline data collection and aggregation across delivery systems and data sources 18

19 Promising Practices: Quality Improvement Grantees are excited to use data to monitor healthrelated behaviors, inform clinical practices, and identify specific enrollees for target interventions Examples of practice improvements documented by grantees: Implemented new processes to improve perinatal care Provided direct access to nutritionists Instituted daily contact with hospital staff Engaged members in the program prior to hospital discharge Encouraged family involvement Implemented patient portals 19

20 Promising Practices: Diffusion Strategies Include QI efforts in future managed care contracts Offer training sessions to providers based on QI projects Make dashboard data public to ensure transparency of information Raise awareness of the importance of clinical quality measures within the state 20

21 Summary Review of Conference Agenda/Goals Q&A Housekeeping Reminders 21

22 Contact Gigi Raney Deirdra Stockmann 22

23 Assessment of the Adult Quality Measures Grant Program Pamela Spain, PhD RTI International

24 Overall Assessment Goals Help the Centers for Medicare & Medicaid Services (CMS) and other Medicaid stakeholders gain a deeper understanding of the feasibility of implementing the core measures Identify effective strategies grantees have implemented that have resulted in successful collection, reporting, analysis, and use of the measures Assess the strengths and weakness of the grant program overall Disseminate information about the grant program to CMS, state and federal Medicaid agencies, and other key stakeholders 24

25 Technical Approach to the Assessment Three key assessment tasks: Task 1 Review and Assessment of the Grant Program Task 2 Summarizing the Grantee Projects Task 3 Learning and Diffusion 25

26 Task 1: Review and Assessment of the Grant Program Provide an overall review and assessment of the grant program and provide CMS with a report on each grantee Key activities for this task include: Reviewing grantee-submitted reports Interviewing grantees and CMS regional project officers via teleconference 26

27 Task 2: Summarizing Grantee Projects Create for CMS stand-alone documents containing more indepth and comprehensive grantee information 3 main types of summary reports 26 Grantee Summary Reports: How grantee developed methods for collecting and reporting measures; how capacity was enhanced; overview of the QI projects within the state, etc. 20 QI Summary Reports: e.g., asthma care, substance abuse, reducing preterm births, improving follow-up after mental health hospitalization, etc. 4 In-Depth Project Briefs: In-depth reports on specific grantees and/or in-depth briefs on specific QI topic areas 27

28 Task 3: Learning and Diffusion On an ongoing and regular basis, our project team will disseminate information about the grant program to CMS and other external and internal stakeholders 3 main learning and diffusion techniques include: 1) PowerPoint presentation 2) Web page content for Medicaid.gov 3) Webinar series 28

29 Assessment Timeline Reviewing Grantee Documentation and Teleconferences Teleconferences with Grantees: April-May 2015 Will inform grantee summary reports and other deliverables 29

30 Contact Information Pamela Spain, PhD RTI International 30

31 Discussion Question and Answer 31