presented by alexis chettiar, acnp- bc, phd st , 2018 npa … · 2019-12-18 · presented by alexis...
TRANSCRIPT
P r e s e n t e d b y A l e x i s C h e t t i a r , A C N P - B C , P h DJ u n e 1 s t , 2 0 1 8
N P A S u m m e r Q u a l i t y C o n f e r e n c e
Q u a l i t y L e a d e r s i n t h e P A C E M o d e l
1 Organizational structure
3. External reporting; CMS and State Administering Agency (SAA)
4. Quality Improvement: QAPI and non-QAPI5. Continuous quality improvement (CQI)6. Defining quality goals7. Leadership; vision, data and process
2. Internal reporting
1 Purpose of a QI program
Role of a PACE Quality Director; Purpose of a Quality Improvement Program
Quality Leaders in the PACE Model
1. Purpose of a QI program
2. Organizational Structure
3. Internal Reporting
4. External Reporting
5. Quality Improvement
(QI)
6. Continuous QI
7. Quality Goals
8. Quality Leadership
Ensure Regulatory Compliance
Federal, state, county, city and non-
governmental agencies
Optimize Quality of Care
Participants-centeredIndividualized
Community-based
Improve Organizational
Culture
Continuous quality improvement
Staff/leadership engagement
Increase EfficiencyProcessSystems
Quality Leaders in the PACE Model
1. Purpose of a QI program
2. Organizational Structure
3. Internal Reporting
4. External Reporting
5. Quality Improvement
(QI)
6. Continuous QI
7. Quality Goals
8. Quality Leadership
Role of a PACE Quality Director; Organizational Structure
SurveyDo you report to
• CEO or other executive leader?• CMO or other medical leader?
• COO or other operations leader?• CNO or other nursing leader?
Quality leaders most commonly report to • CEO
• CMO
• Clinical Operations leader
• Some combination of the above
Quality leaders……. • Work across departments
• Must be well versed in the organizational goals and priorities
• Align departmental quality improvement initiatives with broader organization objectives
• Develop an organization-wide QI/QAPI plan
• Promote and model a culture of CQI
• Act as internal consultants for department-level QI initiatives
In addition, quality leaders…… • Develop performance indicators
• Clinical and non-clinical
• Analyze data related to quality surveillance and QI/QAPI monitoring
• Coordinate QI committee activities
• Review complaints, grievances and appeals
Quality Leaders in the PACE Model
1. Purpose of a QI program
2. Organizational Structure
3. Internal Reporting
4. External Reporting
5. Quality Improvement
(QI)
6. Continuous QI
7. Quality Goals
8. Quality Leadership
Role of a PACE Quality Director; Internal Reporting
Internal Quality Reporting
• C o m p l i a n c e w i t h P A C E R e g u l a t i o n s
• M o n i t o r i n g o f h i g h - r i s k q u a l i t y / c o m p l i a n c e a r e a s
• D a t a c o l l e c t i o n a n d a n a l y s i s
• D e v e l o p m e n t o f a d a t a - d r i v e n Q I p l a n
• M o n i t o r i n g o f Q I i n i t i a t i v e s
Using data to drive delivery of high-value healthcare
Style Is A Simple Way Of Saying Complicated Things
PACE Board of Directors
Participant Advisory
Committee
ProvidersStaff
Participants
Internal quality reporting
ProactiveMonitoring
Early identification of quality and compliance issues in high-risk areas
Sample Board Report
• Opportunity to highlight outcomes associated with high-quality care
• Proactive remediation of sub-standard quality and compliance performance
• Monitoring of adverse events
• Prioritization of QI/QAPI initiatives
Set performance targets
Improve quality
Optimize service
Increase efficiency
Plan Prioritize Lead Succeed
Functions of Internal Reporting
Quality Leaders in the PACE Model
1. Purpose of a QI Program
2. Organizational Structure
3. Internal Reporting
4. External Reporting
5. Quality Improvement
(QI)
6. Continuous QI
7. Quality Goals
8 Q lit L d hi
Role of a PACE Quality Director; External Reporting
Role of Quality Department in compliance with PACE reporting requirements
SurveyDoes your quality department report
• HPMS data?• State-required data submissions?
• PACE professional organization required data?
Does the Quality Department in your organization also fulfill the compliance function?
• Yes
PACE AssociationsNational PACE Association State PACE association Benchmark dataQuality outcomes
Partner Organizations Demonstrate quality and utilization outcomes Depends on extent to which your PACE interfaces with external organizations• Adult Day Health Center services• Complex case management
services
CMSHealth Plan Monitoring System
(HPMS)Quarterly reporting
Follow-up call to review auditors’ questions/comments
• Level I• Level II
State Administering Agency Requirements vary state to state
elated to state licensure and receipt of Medicaid funding
Reporting obligations can be complex
Overlap but do not entirely correspond with CMS requirements
External Quality Data Reporting; Quality and Compliance
Why might CMS exempt PACE programs from reporting on HEDIS and other population-health based quality measures?
Additional Compliance Requirements
• Home Health Agency (HHA)• Older Adult Daily Living Center (OADLC)• Adult Day Health Center (ADHC)• Occupational Safety and Health Administration (OSHA)• Health Insurance Portability and Accountability Act
(HIPAA)• City County and State Department of Public Health
Data may be collected for ,and reported to, the following agencies
• Area Agency for Aging• Centers for Medicare and Medicaid Services
(CMS)• Part D compliance• Claims review • Coding accuracy • PACE regulations
Quality Leaders in the PACE Model
1. Purpose of a QI Program
2. Organizational Structure
3. Internal Reporting
4. External Reporting
5. Quality Improvement
(QI)
6. Continuous QI
7. Quality Goals
8 Q lit L d hi
Role of a PACE Quality Director; Quality Improvement• QAPI• Non-QAPI QI
Organizational Strengths and weaknesses• Structural • Human resources • Departmental capacity• Operational performance
QAPI plan• CMS-mandated• Must address 5 domains
• Participants and caregiver satisfaction
• Effectiveness and safety of services delivered to participants
• Non-clinical• Data collected during participant
assessments • Utilization of services • Per PACE Manual “POs must have a written QAPI plan. POs must have their QAPI plan reviewed annually by the PACE governing body.” Organizational priorities
• Growth • Partnerships
Participant needs• Health outcomes • Satisfaction measures• Risk assessment
Developing a Comprehensive QI Plan O r g a n i z a t i o n a l F a c t o r s
Stakeholders in the QI Plan
• Executive leadership• Medical services
• Operations • All departments
Quality leader
CMO
CEO
COO
R e g u l a t o r y R e q u i r e m e n t s
State-level regulatory requirements
ReengineeringFocused, targeted modificationsChange management
Outcome measurementInitial assessmentSubsequent reevaluation Severity of the problem Frequency of occurrenceImpact on participant outcomes
Statistical analysisThreshold development
System designProcess analysis/improvement
PDSAFailure modes and effects analysis (FMEA)
Components of the QI Process
Data as the Foundation of Quality Improvement• Identify opportunities for quality improvement
• Track Trends
• Assess performance
• Create evidence-based QI program
• Evaluate impact of QI initiativesData differentiates fact from myth, rumor, preference and belief
Discussion PointWhat are the limitations of data as the foundation for developing a QI
l ?
Quality Leaders in the PACE Model
1. Purpose of a QI Program
2. Organizational Structure
3. Internal Reporting
4. External Reporting
5. Quality Improvement
(QI)
6. Continuous QI
7. Quality Goals
Role of a PACE Quality Director; Continuous Quality Improvement
• Foster conversion of complaints to constructive action• Promote engagement through initiatives such as
• ‘Tip line’• Employee councils• Involvement of stakeholders at all levels of the
organization • Act as internal consultant
• Facilitate development of department-level QI initiatives• Educate staff and leaders on change management
(PDSA)• Pre-implementation communication• Development of measurable goals • Training resources• Post-implementation follow-up• Reevaluation and revision
Role of quality leaders in developing a culture of CQI
D e v e l o p i n g a c u l t u r e o f C Q I
Quality Leaders in the PACE Model
1. Purpose of a QI Program
2. Organizational Structure
3. Internal Reporting
4. External Reporting
5. Quality Improvement
(QI)
6. Continuous QI
7. Quality Goals
8 Quality Leadership
Role of a PACE Quality Director; Quality Goals
Develop goals• Set of actions /outcomes • Pathway to accomplishing
objectives
Time frame• Time by which goal targets will be
achieved
Measurable outcomes• Quantifiable metrics for each
goal• Valid, reliable measures
Define objectives• Overarching intent
Owner of activity• Person/team/department • Executing vs. reporting
Plan for reevaluation• Time frame
• Format• Forum
• Person/team accountable
Setting Goals and Objectives
Measure typeProcess measureResources measureOutcome measure
Potential Positive Impact Quality of lifeImproved health outcomes• Functional status • Cognitive capacity• Nutrition• Primary, secondary and
tertiary prevention Satisfaction with PACE programCongruence of care with expressed preferences
Avoidance of Adverse OutcomesInjury Unexpected death Medication errorsAbuseNeglect
Prioritizing QI Goals
Quality Leaders in the PACE Model
1. Purpose of a QI Program
2. Organizational Structure
3. Internal Reporting
4. External Reporting
5. Quality Improvement
(QI)
6. Continuous QI
7. Quality Goals
8 Quality Leadership
Role of a PACE Quality Director; Quality Leadership• Vision• Data• Process
Data• Internal data collection and analysis
• Benchmarking internal data against external
quality standards
• Interpretation and presentation
• Foundation for prioritizing high-value quality
improvement initiatives
Organizational Systems• Synthesize with data interpretation
• Map existing systems
• Develop QI initiatives to bridge gap between
actual and ideal systems
• Data driven
• Detailed
• Thorough
Communication • Coordinate efforts
• Involve stakeholders in QI/QAPI development
• Development
• Implementation
• Post-implementation evaluation
• Bring vision of leadership to staff
• Convey staff-level issues to leadership team
Education • Ensure buy-in for QI/QAPI initiatives
• Target education based on audience
• Data-driven approach
• QI integration into orientation and training
• Training on monitoring and measurement of
quality indicators
Q u a l i t y L e a d e r s i n t h e PAC E c a r e m o d e l … .
Use development and implementation of QI initiatives to instill a culture of CQIWork with the senior leadership team Use data to assess organizational strengths and weaknesses
Create QI plan that addresses organizational challenges Align QI plan with organizational goals and priorities
Act as internal consultants
Provide on-going analysis and reevaluation of quality trends