the commonwealth fund the long-term quality alliance and its innovative communities initiative mary...
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THE COMMONWEALTH
FUND
The Long-Term Quality Alliance and its Innovative Communities Initiative
Mary Jane Koren, M.D., M.P.H.
VP LTC Quality Improvement, The Commonwealth Fund
Grantmakers in Health Annual Meeting
March 8, 2012
With thanks to Pat Sprigg from Carol Woods in NC for some of these slides
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What is the Long-Term Quality Alliance?
• Inaugurated in 2010
– A coming together of diverse stakeholders striving for balance between provider, consumer and other groups
– First chair Mary Naylor, current chair Carol Raphael
• Purpose: To improve the effectiveness and efficiency of care and the quality of life of people receiving long-term services and supports by fostering person- and family-centered quality measurement and advancing innovative best practices.
• Initial focus: care transitions – from the LTSS side of the equation
– Measurement
• Develop and test new measures or adapt existing measures
• Harmonize with other measures proposed or in use (AHRQ; NQF; NCQA)
– Quality improvement
• Conduct pilots and demos to test or adapt proven practices
• Collaborate with existing QI organizations to support interventions and track data (QIOs, IHI, trade associations, others)
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Why transitions?
Nursing Home
Assisted
Living
Rehabilitation
Continuing Care Retirement Community
Home
County Council/
Department on Aging
Area Agency
on Aging
Cooperative Extension
Mental Health
Provider
Community Resource Connection
Home Health Care
Senior Center
Adult Day Services
Faith Community
County Social
Services
?
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“If (re)hospitalizations are frequent, costly, and able to be reduced, why haven’t they been?”
Challenges exist on multiple levels: • Hospital-level barriers
– Financial disincentives, no financial incentives, not high on priority list, limited knowledge / sharing of disease-specific efforts & care transition interventions among hospitals
• Community-level barriers– Not common to engage organizations across continuum of
services to collaborate on improving care, lack of IT connectivity, no reimbursement for coordination & systems and organizations working in silos
– We stay within the health care box and don’t look at the contextual issues, e.g. transportation, full-service grocery stores, housing, public safety, legal services and guardianship
• State-level barriers– Lack of population-based data, lack of understanding
costs of poor quality on systems, effect of fragmented payer market and lack of CMS participation
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The Innovative Communities Initiative
• Time is ripe: hospitals now have an incentive (as per the ACA) to collaborate with LTSS providers to improve transitions from one level of care to the next
– Medicare to recover payments made to hospitals for unnecessary readmissions within 30 days of discharge beginning in October 2012
• Delivery system change happens at the local level
• Community delegations of 3-5 individuals invited to attend the first LTQA Summit* (12/10)
– Shared challenges and solutions
– Explored participating in the ICI
• Collective action is required for lasting impact – it takes a community
*Supported by the SCAN Foundation
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Collective action to achieve collective impact*
Collective impact initiatives represent ongoing commitments by key stakeholders from different sectors to a common agenda for solving a specific social problem• Step 1: Assembling the components
– Identify and develop a supporting infrastructure– Forge new partnerships across interest groups – Build strong working relationships among important players
through continuous, ongoing communication – Concentrate on identifying and then addressing the common
problem – Jointly agree on what success will look like and have a shared
measurement system to track progress towards the goal– Use mutually reinforcing activities to maximize existing
resources
• Step 2: Sustaining gains
*Kania and Kramer, Collective Impact; Stanford Social Innovation Review, Winter 2011
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Key Partners
DHHSCommunity Connections
Com
munit
y Serv
ices
Health
Care
Consumers
AD
RCs
Policy
CM
S/A
oA
Communities across the US are beginning to consider transitions of care as a community –based challenge that requires shared
ownership and close collaboration across settings. (Institute for
Healthcare Improvement)
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From Communication
To Cooperation
To Coordination
To Collaboration
Community Engagement is a journey, and, like any journey, it takes time
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Lessons from the field: Listening to the LTQA’s Innovative Communities
• Identify a Change Agent
• Stakeholders: Consumers: Make the Case
• Encourage Collaboration: Public & Private Partnerships
• Build Synergy: But Keep Alignment
• Demonstrate Impact (Now vs. Future)
• Choose Intervention –Find the Fit-Don’t Duplicate
• Capture the Data – who/what/how/why
• Sustainability is Critical!
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The role of LTQA
• Serve as a repository of information
• Propose and promote common definitions and terminology
• Be a coach and a convener for the communities
• Identify state and federal funds to assist the collaboratives
• Launch a consumer education campaign
• Educate public officials and lawmakers
• Advocate at the national level for flexibility to innovate
• Identify regulatory barriers to innovation
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11
What can you do?
• Examine your foundations priorities – could they be furthered by the creation of an LTQA type Innovative Community?
• Discover what your community/region/state is already doing – lots of good things may be underway already but struggling and you can give them wings
• Convene• Provide technical assistance; build infrastructure• Give seed money • Reward achievements• But just DO something – don’t walk away because the long-term
services and supports issues are big and complex
Remember –
The way to eat an elephant is one bite at a time!