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