2003 Real Choice 2003 Real Choice Grant: UpdateGrant: Update

Quality Close to Home: Building Quality Close to Home: Building Tools for Quality Tools for Quality

Assurance/Quality Assurance/Quality Improvement in Home & Improvement in Home &

Community-Based ServicesCommunity-Based Services

General Purpose of the Real General Purpose of the Real Choice CMS GrantsChoice CMS Grants

Provide funding to states to make significant, Provide funding to states to make significant, enduring changes to infrastructure supporting enduring changes to infrastructure supporting HCBS consumersHCBS consumers

Promote, promulgate “best practices” Promote, promulgate “best practices” developed by states .developed by states .

Hot topics: consumer direction, quality Hot topics: consumer direction, quality mgmt/CQI, employment, relocation, family mgmt/CQI, employment, relocation, family support, incidence managementsupport, incidence management

MN’s 2003 Real Choice GrantMN’s 2003 Real Choice Grant

Grant $ builds needed quality tools:Grant $ builds needed quality tools:

VA Data Collection systemVA Data Collection system

Data Mart: mini-warehouse to integrate data from MMIS/EIS, Data Mart: mini-warehouse to integrate data from MMIS/EIS,

county visits, investigative agencies, complaint offices, etc. county visits, investigative agencies, complaint offices, etc.

Creates broader, deeper reports & analysis capacityCreates broader, deeper reports & analysis capacity

Consumer survey: make sure we hear about quality of life Consumer survey: make sure we hear about quality of life

and services from people supported under the programsand services from people supported under the programs

Systems-generated communication to case managers, Systems-generated communication to case managers,

agencies agencies

Source of information to build provider profiles for Source of information to build provider profiles for

MinnesotaHelp.infoMinnesotaHelp.info

Broad Goals of 2003 Grant .Broad Goals of 2003 Grant .Will support DHS quality management strategy developed for Will support DHS quality management strategy developed for HCBSHCBSSupport CQI in HCBSSupport CQI in HCBS

Will help address identified areas for improvement in quality Will help address identified areas for improvement in quality

management management Ensure tools serve broadest purpose in quality assessment, Ensure tools serve broadest purpose in quality assessment, measurement, and uses of findings measurement, and uses of findings Plan for public dissemination of findings: consumer usesPlan for public dissemination of findings: consumer usesPlan to ensure support when things need to be fixed Plan to ensure support when things need to be fixed (remediation) “So what”(remediation) “So what”Identify barriers, challenges to completion of HCBS quality Identify barriers, challenges to completion of HCBS quality management objectivesmanagement objectivesCoordinate consumer inputCoordinate consumer inputMeet federal mandate under new QA frameworkMeet federal mandate under new QA framework

Minnesota’s HCBS Programs: AC, Minnesota’s HCBS Programs: AC, CAC, CADI, EW, MR/RC, TBI-NF, CAC, CADI, EW, MR/RC, TBI-NF,

TBI-NBTBI-NBShare common eligibility criteriaShare common eligibility criteriaShare common quality assurance requirementsShare common quality assurance requirementsProgram areas each commit resources to quality Program areas each commit resources to quality assessment, improvementassessment, improvementMakes sense to coordinate, target, ensure CQI Makes sense to coordinate, target, ensure CQI loop = quality management strategyloop = quality management strategy

Quality Management Diagram: Quality Management Diagram: Possible ActivitiesPossible Activities

C o n tin u in g Care A d m in istra tio n 's Q u ality M anag em en t S trategy

F eedbac k loops toquality im provem en t

activ ity

Desk Audit: data based measuresA d hoc and pro duction querie s

F eedbac k loops toquality im provem en t

activ ity

Field audit: On site visitsC ounty im p lem entation of program s

P rov ider pe rform ance, com plianc e

Other DHS activityO ther D ep artm ents, e .g H ealth

F eedbac k loops toquality im provem en t

activ ity

Consumer InputS urveys, da ta m easure sT argeted consum er inpu t

F eedbac k loops toquality im provem en t

activ ity

Client Record ReviewR andom sam ple

C are p lan, a ssessm en t

F eedbac k loops toquality im provem en t

activ ity

Management Review, AssistanceT ra in ing & T ech A ss is tanc e

O ngoing, ta rgete d

Quality Assessm ent & Im provement Activities:A cce ss , C ap a c ity, C h o ice , R ig h ts, H e a lth & S a fe ty, A cco u n ta b ility

Grant Widens the Window of Grant Widens the Window of OpportunityOpportunity

-- MinnesotaHelp.info: Provider profiles/report card: What MinnesotaHelp.info: Provider profiles/report card: What do we/consumers want to know about quality of service do we/consumers want to know about quality of service or care, where/how information is collected, how to import or care, where/how information is collected, how to import it to MinnesotaHelp.info it to MinnesotaHelp.info

-- Shared Master Index project: creates opportunity to Shared Master Index project: creates opportunity to identify people in VA report system. identify people in VA report system.

-- Recaptures attention to quality strategy, performance Recaptures attention to quality strategy, performance measures, etc.measures, etc.

Focusing the GrantFocusing the Grant

Minnesota needs:Minnesota needs: Well-integrated incidence management systemWell-integrated incidence management system Complete, consistent information for quality Complete, consistent information for quality

measurement and improvementmeasurement and improvement Interface between pertinent information systemsInterface between pertinent information systems Better ways to link data to continuous quality Better ways to link data to continuous quality

improvement opportunities (program and policy improvement opportunities (program and policy development)development)

Improving QA/QI DesignImproving QA/QI Design

Ability to identify individuals in HCBS in non-MMIS data Ability to identify individuals in HCBS in non-MMIS data

bases is limited bases is limited

Efficient QA/QI design given resourcesEfficient QA/QI design given resources

Ensure QA efforts support achievement of state goals Ensure QA efforts support achievement of state goals

as well as federal compliance: develop QA/QI plan, as well as federal compliance: develop QA/QI plan,

tools for Minnesotatools for Minnesota

Indicators at various levels: program, consumer, Indicators at various levels: program, consumer,

county, provider, populationcounty, provider, population

Consumers & Quality Consumers & Quality

Info about quality that would support consumer choice-Info about quality that would support consumer choice-

making: provider profiles, e.g.making: provider profiles, e.g.

Strategy and products to communicate quality findings to Strategy and products to communicate quality findings to

publicpublic

Quality of life/care indicators that matter to people Quality of life/care indicators that matter to people

supported under the programssupported under the programs

Requires ongoing consumer input: QDCRequires ongoing consumer input: QDC

Vulnerable Adult Report Data System Vulnerable Adult Report Data System Product DetailsProduct Details

Evaluates use of SSIS for county VA/AP data Evaluates use of SSIS for county VA/AP data submissionsubmission

Extracts data from counties with mature databasesExtracts data from counties with mature databases

Will improve consistency, completeness of report Will improve consistency, completeness of report datadata

8 volunteer counties to build, test8 volunteer counties to build, test

HIPPA compliant (paper submission of sensitive HIPPA compliant (paper submission of sensitive data at present)data at present)

VA Report Data Collection Product VA Report Data Collection Product DetailsDetails

Provide comprehensive and consistent VA Provide comprehensive and consistent VA Report data that can form the basis of Report data that can form the basis of remediation strategies and targeted remediation strategies and targeted improvement efforts. improvement efforts.

Provide a more complete picture of locally Provide a more complete picture of locally investigated reports (about 40% of all investigated reports (about 40% of all reports).reports).

Vulnerable Adult Report Data Vulnerable Adult Report Data System Product DetailsSystem Product Details

Allows individuals to be identified with creation Allows individuals to be identified with creation of Shared Master Index, VA Report identifierof Shared Master Index, VA Report identifier

Systems-generated communication with case Systems-generated communication with case managers, agenciesmanagers, agencies

Help us identify trends, target TAHelp us identify trends, target TA Will be critical for CDCS health/safetyWill be critical for CDCS health/safety

Consumer Input into QA/QI: Consumer Input into QA/QI: Product DetailsProduct Details

Ombudsman volunteers help pilot, retest tool, conduct Ombudsman volunteers help pilot, retest tool, conduct ongoing surveysongoing surveys

Pilot EW survey tool is done, ready for testing. Added Pilot EW survey tool is done, ready for testing. Added measures related to social roles, relationships, need measures related to social roles, relationships, need some for consumer directed, caregivers, consumer some for consumer directed, caregivers, consumer outcomes to be collected on all HCBS at outcomes to be collected on all HCBS at assessment/reassessment in MMISassessment/reassessment in MMIS

Quality Design Commission: consumer input into survey Quality Design Commission: consumer input into survey work, indicators work, plan for dissemination of QA work, indicators work, plan for dissemination of QA findings findings

Data Mart Product DetailsData Mart Product Details

Quality Data Mart: A place to store & Quality Data Mart: A place to store & analyze quality dataanalyze quality data Integrates existing data bases Integrates existing data bases Interfaces with EIS and MMIS as well as Interfaces with EIS and MMIS as well as

Licensing, MDH, Appeals, Ombudsman, e.g. Licensing, MDH, Appeals, Ombudsman, e.g. Could also store non-MMIS data (e.g. Could also store non-MMIS data (e.g. Licensing review information, MH data)Licensing review information, MH data)

Can be supported within the existing IT Can be supported within the existing IT environment environment

Data Mart Product DetailsData Mart Product DetailsWill house data from VA Report System, County Will house data from VA Report System, County Assessment Visits, Consumer Surveys, extracted Assessment Visits, Consumer Surveys, extracted data from other relevant sources (MDH, eg)data from other relevant sources (MDH, eg)

Can be created with several levels of secured Can be created with several levels of secured access: county reports, management/division, ad access: county reports, management/division, ad hochoc

Would be source of HCBS provider profile Would be source of HCBS provider profile information for MinnesotaHelp.infoinformation for MinnesotaHelp.info

Successful Project Can Help Successful Project Can Help Minnesota: Minnesota:

Improve incidence managementImprove incidence management

Make best use of QA/QI resourcesMake best use of QA/QI resources

Coordinate quality activity into a quality Coordinate quality activity into a quality management strategymanagement strategy

Respond to Elder Justice Act that will Respond to Elder Justice Act that will require nat’l reporting of abuse of eldersrequire nat’l reporting of abuse of elders

Successful Project Can Help Successful Project Can Help Minnesota:Minnesota:

Offer different QA/QI strategy, tools, measures for Offer different QA/QI strategy, tools, measures for consumer directed service optionsconsumer directed service options

Develop data driven CQI, program evalDevelop data driven CQI, program evalDevelop better public dissemination of quality Develop better public dissemination of quality

information/findings, including provider profile information/findings, including provider profile informationinformation

Meet federal compliance with new HCBS QA Meet federal compliance with new HCBS QA frameworkframework

Work Plan & TimelineWork Plan & TimelineBusiness Analysis contract: hired effective June 9Business Analysis contract: hired effective June 9 thth. . Data mart design specs, VA data collection method Data mart design specs, VA data collection method & specs (includes review of other states): Dec, 2004& specs (includes review of other states): Dec, 2004

EW Consumer Survey: Pilot version completed, EW Consumer Survey: Pilot version completed, surveys will start mid-Julysurveys will start mid-July

Random statewide EW survey: wtr/sp, 2005Random statewide EW survey: wtr/sp, 2005

VA work group: 8 counties, finalizing forms data & VA work group: 8 counties, finalizing forms data & process requirementsprocess requirements

QA/QI data mart built: July, 2005QA/QI data mart built: July, 2005

VA Reporting System on line: Sept 2005VA Reporting System on line: Sept 2005

View of QA/QI Data MartView of QA/QI Data Mart

M D H d a ta A p pe a ls da ta V A R e po rt d a ta O m bu d sm an L icen s in g d a ta S u rve y & w a ive r au d it d a ta

QA/QI Data M art: Tiered WarehouseE IS d a ta e xtra cte d a n d s to re d h e re in a "m in i" w are ho u se

D a ta from "o ff-lin e " d a ta b ase s e x tra c te d an d s to re d he re , in clu d in g V A re p ort da ta , a n d con sum e r su rve y d a taQ u e rie s , re p orts re la te d to se le cte d q u a lity m e a sure s , q u a lity a sse ssm e nt, q ua lity im pro vem e nt

M M IS/EIS : Data Warehouse

MMIS/EIS

MAXIS(Health Match)

Other... License Reviews, HwServices Registry Info, Ombudsman Data

DataSources

SSIS

Education

Employment

Health

Housing

Corrections

Courts

Social Services

Health Care

Family Support

Institutional/ResidentialQuality Data Mart

Dept ofEconomicSecurity

Dept ofHealth Investig & Other

Potential Data Relationships for Potential Data Relationships for Quality Data MartQuality Data Mart

VA Data

Federal Assurances in MA-Funded HCBSFederal Assurances in MA-Funded HCBShttp://www.cms.hhs.gov/medicaid/waivers/frameworkmatrixhttp://www.cms.hhs.gov/medicaid/waivers/frameworkmatrix

The Matrix: HandoutThe Matrix: Handout Outlines domains that states must address in Outlines domains that states must address in

program & quality designprogram & quality design Outlines expected outcomesOutlines expected outcomes Outlines primary functions of state monitoring Outlines primary functions of state monitoring

and oversightand oversight Emphasizes the need for continuous quality Emphasizes the need for continuous quality

improvement mechanismsimprovement mechanisms Focuses on consumer input in the quality Focuses on consumer input in the quality

designdesign