HIV/AIDS BureauDivision of State HIV/AIDS Programs (DSHAP)

Ryan White HIV/AIDS Program Part BTechnical Assistance Webinar

Building a Quality Management Program

January 15, 2014

2

DSHAP Mission

To provide leadership and support to States/Territories for developing and ensuring access to quality HIV prevention, health care and support services.

3

Agenda

Opening Remarks/ Announcements Heather Hauck

Question and Answer

Report on DSHAP’s 2013 Webinars Katherine Patterson, Magnus Azuine

The Ryan White HIV/AIDS Program Moving Forward – Quality Initiatives

Heather Hauck

Clinical Quality Management Susan Robilotto

Georgia Quality Management Program Eva Williams

Questions and Answer

Closing Remarks Heather Hauck

4

Presenter

Heather HauckDirector

Division of State HIV/AIDS Programs

5

Announcements & Updates

6

Announcements

FY14 RWHAP Part B Base/ADAP Earmark (X07) Awards

Important Deadlines:•The due date for the next X07 ADAP Quarterly Report (AQR) Submission (for the 10/1/13-12/31/13 reporting period) is 1/31/2014. •The AQR is being phased out. 4/30/14 will be the last AQR grantees will be required to submit.•Unobligated Balances (UOB) Estimated Carryover: due January 31, 2014

7

2013 Ryan White RSR and ADRSubmission Timelines

Date RSR ADRGrantees ProvidersMonday, December 2, 2013 RSR Grantee Report Start Date

System opens for grantees to begin work on their RSR Grantee Report.

Monday, January 6, 2014 RSR Provider Report Start Date System opens for providers to begin work on their RSR Provider Reports and upload their client-level data files.

Monday, February 3, 2014 6:00 p.m. EST

RSR Grantee Report due date All RSR Grantee Reports must be in “Certified” status. After this deadline, grantees must contact Data Support to certify or to make changes to their RSR Grantee Reports.

Monday, March 3, 2014 2013 ADR Client XML Test Site Opens

Monday, March 10, 2014 Target date for the submission of all RSR Provider Reports and client-level data. RSR Provider Reports should be in “Review” or “Submitted” status.

Monday, March 24, 2014 Return for Changes deadline Last day for grantees to return RSR Provider Reports and client-level data to their providers for changes or corrections.

Monday, March 31, 2014 6:00 p.m. ET

All RSRs must be in “Submitted” status by 6:00 PM ET.

All RSRs must be in “Submitted” status by 6:00 PM ET.

Thursday, April 10, 2014 ADR Web System Opens for 2013 Data Collection

Monday, June 9, 2014 6:00 p.m. ET

2013 ADR is Due to HRSA

8

New SPNS FY 14 FOAs Released:•System-level Workforce Capacity Building for Integrating HIV Primary Care in Community Health Care Settings – Demonstration sites HRSA 14-055

• Deadline: March 10, 2014•System-level Workforce Capacity Building for Integrating HIV Primary Care in Community Healthcare Settings – Evaluation and Technical Assistance – HRSA 14-058

• Deadline: March 10, 2014•HRSA/HAB will host a technical assistance (TA) webinar Wednesday, January 29, 2014 from 2:00 – 4:00pm EST (HRSA-14-055) and Thursday, January 30, 2014 from 2:00 – 4:00pm EST (HRSA-14-058) Register http://careacttarget.org/events

9

Questions

10

A Review of DSHAP’s 2013 Webinars

11

Respondents

12

Number of Years in Position

13

Topics of Interest

Healthcare Reform in States 28%

2013 Reauthorization 24%

National Monitoring Standards 18%

Early Intervention Services and working with CDC/ ADAP Eligibility, Enrollment and recertification

6%

National HIV AIDS Strategy/ HAB Performance Measures/Quality Management Plans/Insurance continuation through ADAP

4%

Maintenance of Efforts/Pharmacy Benefits Management overview and how to work with PBMs

2%

14

DSHAP 2013 Webinars

January 30, 2013 ADAP and Federal PCIP Coordination

February 13, 2013 2013 TA Webinars Feedback and Part B Program Updates

March 26, 2013 Clarifications on Client Eligibility Assessment and Recertification Requirements

April 30, 2013 Carryover Requests and Federal Financial Reports (FFR): Tracking and Reporting of Rebates

June 11, 2013 National Monitoring Standards Update and Schedule of Charges

June 26, 2013 FY 2013 Part B Supplemental Funding Opportunity Announcement (FOA) and the ADAP ERF FOA

October 10, 2013 FY 2014 Ryan White HIV/AIDS Program Part B /ADAP Earmark Funding Opportunity Announcement

October 31, 2014 ADAP ERF 2014 FOA

15

NASTAD Cooperative Agreement

March 2013 ADAP Crisis Lessons Learned

March 2013 Financial Forecasting Part One

May 2013 Financial Forecasting Part Two

May 2013 ADAP and Health Reform

June 2013 ADAP and Insurance

September 2013 ADAP Application and Coordination with ACA

October 2013 Plan Assessment

16

Other HAB Sponsored Webinars

• August 14, 2013; “Preparing for 2014: Overview of Ryan White HIV/AIDS Part B Program policy updates and guidance” sponsored by HAB

• August 29, 2013; “Better Together: State Strategies for Medicaid-Ryan White HIV/AIDS Program Coordination” sponsored by National Academy of State Health Policy through its cooperative agreement with HRSA

• November 20, 2013; “The Ryan White Program and Understanding Modified Adjusted Gross Income (MAGI)” sponsored by the HIV/AIDS Bureau in partnership with the CMS.

• December 4, 2013; “The Ryan White HIV/AIDS Program in States Not Expanding Medicaid” sponsored by HIV/AIDS Bureau

17

Grantee Topics Completed

Healthcare Reform in States

2013 Reauthorization

National Monitoring Standards

Early Intervention Services and working with CDC

ADAP Eligibility, Enrollment and recertification

National HIV AIDS Strategy

Quality Management Plans

Insurance continuation through ADAP

HAB Performance Measures

Pharmacy Benefits Management overview; how to work with PBMsMaintenance of Effort

18

Additional Topics

• Cap on charges & sliding fee scales• Role of case managers in outreach and

enrollment in Marketplace• Impact of ACA on Ryan White• Ryan White Services Report• Implementation of insurance continuation

programs & ACA• Quality Management Plans• ADAP Data Report (ADR)

19

How Did We Do?

• The division met and exceeded it’s goal• 54% of grantee topics addressed • A total of 19 technical assistance

webinars completed. An increase of 130%!

20

2014 Webinar Evaluation

Option 1

Option 2

Kpatterson@hrsa.govmazuine@hrsa.gov

Building a Quality Management Program

Building a Quality Management Program

HAB Expectations

Heather Hauck, MSW, LICSWDirector Division of State HIV/ AIDS Programs

Objectives

HAB expectations for a Quality Management Program

Components of a Quality Management Program

Grantee Presentation

Zero New Infections

The Ryan White Program funds comprehensive HIV care systems for low-income individuals and families to reduce new HIV infections, to improve health outcomes for PLWH, and to reduce HIV-related health disparities.

HAB ensures the maximum effectiveness of the Ryan White Program by assessing the HIV care and service needs of PLWH, shaping HIV policy, assessing models of care and services required, providing target training of the health care workforce, providing leadership on national HIV/AIDS quality measures.

Empower stakeholders to deliver high quality HIV care and treatment across the nation.

Establish and monitor key HIV quality measures/indicators to assure high-quality care that address all stages of the care continuum and adhere to DHHS standards.

Collect, analyze, and utilize data on health outcomes of PLWHA to improve and advance the treatment of care.

Quality

HAB advances evidence-based, cost effective HIV care and treatment through the provision of training and capacity development grants and cooperative agreements.

HAB provides leadership on national HIV/AIDS quality measures, including the development, alignment among HHS OPDIVS and other federal agencies and adoption of these measures by Ryan White clinical providers.

HAB promotes clinical quality improvement by HAB staff and grantees through capacity development, monitoring grant activities and implementing special projects and studies.

Quality

Components of a Quality Management Program

Susan Robilotto, D.O.Clinical Consultant

Division of Metropolitan HIV/AIDS ProgramsDivision of State HIV/AIDS Programs

Ryan White HIV/AIDS Treatment Extension Act

All Ryan White grantees are required to establish clinical quality management programs to:

Programmatic Expectations

Funding Opportunity Announcement provides minimum expectations for grantees. Established and implemented a clinical quality

management plan; Established processes for ensuring that Primary

Medical Care services are provided in accordance with the Department of Health and Human Services (DHHS) treatment guidelines and standards of care; and

Incorporated quality-related expectations into Requests for Proposals (RFP) and contracts.

Components of a QM Program

Quality Infrastructure

Quality Management Plan

Performance Measures

Quality Improvement Projects

Quality Infrastructure

Infrastructure enhances systematic implementation of improvement activities.

Infrastructure

Quality Infrastructure

Quality Management Committee

Leadership

Stakeholders

Quality Management Committee

Builds the HIV program’s capacity and capability for quality improvement

Involves program leaders and other key staff to cement their personal commitment to quality

In a large organization, links the HIV quality program with the organization’s overall quality program

Who might be on the committee?

Leadership

Clearly articulated mission and vision statement

Ongoing measurement of performance

Ongoing assessment by leaders

Active coaching by leaders

Stakeholders

How will staff, providers, consumers and others be involved in the CQM program?• Engage internal and external

stakeholders• Communicate information about quality

improvement activities• Provide opportunities for learning about

quality

Quality Management Plan

A quality management plan is a written document that outlines the grantee-wide HIV quality program, including a clear indication of responsibilities and accountability, performance measurement strategies and goals, and elaboration of processes for ongoing evaluation and assessment of the program.

Updated quality management plans are going to be requested from all Part B grantees in FY14

Quality Management Plan of a Quality Management Plan

1. Quality statement

2. Quality infrastructure

3. Performance measurement

4. Annual quality goals

5. Engagement of stakeholders

6. Evaluation

The 10 QM Plan Rules

1. Do not reinvent the wheel, use established frameworks to get started

2. ‘Steal Shamelessly, Share Senselessly’

3. Size does not matter

4. 80% planning, 20% writing (old software programming rule)

5. A few visionary annual goals are better than plenty of useful ones

The 10 QM Plan Rules (cont.)

6. Be inclusive, even if it takes longer to get your final QM plan

7. If you have not touched your plan in the last 6 months, bring it to the next quality committee meeting

8. A perfect plan is never written

9. Plans are only as good as their implementation

10. Get started

Performance Measures

Importance of Performance Measures:

Separating what you think is happening from what is really happening

Establishing a baseline and allowing for periodic monitoring

Determining whether changes lead to improvements

Comparing performance with others

Linking performance data to quality improvement activities

HAB Performance Measures

2007: Started developing and releasing measures under the guidance of Dr. Cheever

Currently 46 measures spanning clinical care, oral health care, ADAP, case management, and systems

Alignment and streamline measure across federal programs

Core measures received National Quality Forum endorsement in February 2013

http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html

Quality Improvement Projects

Imbalance Balance

Quality Improvement ProjectsPDSA Cycle

Quality Management Program

QM Program evaluation tool

– Developed to help project officers and consultants to better evaluate QM Programs during site visits

– Identify if a program is meeting legislative requirements

– Identify areas in which a program has established “best practices”

– Identify areas where a program needs to improve in order to provide a high quality system of care

Quality Management Program

Resources:

National Quality Center (NQC)

http://nationalqualitycenter.org/index.cfm

NQC Quality Academy

http://nationalqualitycenter.org/index.cfm/5847/8860

HIV/AIDS Bureau (HAB) Performance Measures

http://hab.hrsa.gov/deliverhivaidscare/habperformm easures.html

Georgia Department of Public Health

Ryan White Part B

Quality Management Program

HRSA TA WebinarBuilding a Quality Management Program

January 15, 20143:00 – 4:00 PM

Acknowledgments• Rosemary Donnelly, SEATEC Clinical Director• Pamela Phillips, RW Part B QM Coordinator• Michael Coker, RW Part B HIV Nurse Consultant• Rachel Powell, RW Part B QM Data Manager• Marisol Cruz, RW Part B Care Manager• William Lyons, HIV Office Director• Kim Brown, HRSA Project Officer• RW Part B QM Core Team and Subcommittees• National Quality Center • RW Part B-funded health district staff• Representatives/Grantees of other Georgia RW

Parts

RW Part B QM Team Structure

Part B-Funded Health Districts1-1 Rome1-2 Dalton3-1 Cobb-Douglas3-3 Clayton3-4 East Metro4-0 LaGrange5-1 Dublin5-2 Macon6-0 Augusta7-0 Columbus8-1 Valdosta8-2 Albany9-1 Brunswick/Savannah9-2 Waycross10-0 Athens

**3-2 Fulton and 3-5 DeKalb are funded primarily by Part A

Origins of the QM Program• 1990’s: Nurse consultant for HIV

Prevention asked to assist with quality reviews for medical care– HIV Medical Advisor hired 2000

• 2005: Title II Collaborative with HRSA/NQC– 18 months of TA and support– Developed written QM Plan – Created statewide QM Committee – Additional QM staff hired– Improved buy-in from all stakeholders

Elements of Current Structure

• Georgia RW Part B Program QM Plan• Statewide QM Core Team and

Subcommittees• Expectations for funded health

districts• Data Collection, Reporting and

Analysis

Georgia RW Part B QM Plan

Communication & Coordination

QM Core Team &Subcommittees

Continuous Quality Improvement

(CQI) Projects

Evaluation Data Collection

Local QM Plans & Annex-GIA

Capacity Building (Training and TA)

Part B QM Plan

Georgia RW Part B QM Plan• Implemented April 1 – March 31,

updated annually• Process to evaluate and revise:

– Meetings with stakeholders– Review quality data– NQC Assessments– Federal initiatives– Approval by QM Core Team and HIV

Office Director prior to implementation

Statewide RW Part B QM Core Team

• Purpose: To provide oversight and facilitation of the GA RW Part B QM Plan

• Meetings are held quarterly, face-to-face preferred in a central location for the state

• Composed of multidisciplinary professionals and consumers – Subcommittees: Case Management,

ADAP/HICP– Collaboration with other RW Parts

Funded Health District QM Expectations

• Ensure compliance with DHHS-related guidelines

• Participate in statewide Part B QM Program• Develop and implement local QM Program

– Written QM Plan and work plan updated annually– Leader and team to oversee the Program– QM Goals, objectives and strategies– Communicate results to all levels of the

organization, including consumers as appropriate

Quality Data Collection and Reporting

• Collaborate with Epi/Surveillance• Surveys, e.g. statewide Client Satisfaction

Survey• Clinical and Case Management Chart Review

– Reliable– Limitations in how the data is collected– Time and resource intensive

• CAREWare – Uniform comparison based on data that is entered– Includes all eligible clients – Generally less reliable for some measures and

districts

Overview of a CQI Project• Clinical chart reviews were conducted in 2006• Two areas of improvement were found: dental

exam and cervical cancer screening• Districts not at goal were asked to incorporate

these measures into their local QM Plans• Improvement projects occurred at both the

state and local levels• In 2009, clinical chart review showed modest

improvement in both measures• Currently, clinical chart review data is being

analyzed for CY2012. The data will be compared with 2006 and 2009 to determine trends and next steps

CQI Project Data

Recent Projects• Statewide client satisfaction survey• In+Care Campaign• Collaboration with Medicaid• Case Management Acuity Scale and Self

Management Model• ADAP/HICP CAREWare electronic

application process• Providing quality-related trainings and

technical assistance

Challenges/Opportunities for Improvement

• Time frame for reporting data back to stakeholders

• Innovative ways to improve CAREWare data entry

• Case management training disparity• Technical capacity

Building a Program: Where to Begin?

• National Quality Center trainings and TA

• Peer learning• Obtaining buy-in from senior

leadership and stakeholders• Using tools from NQC outlining what a

quality program should look like– Written QM Plan– QM Committee– Process for data collection and reporting

Keeping the Program Strong• National Quality Center Trainings and TA• Buy-in is an ongoing process• Demonstrating the value of quality work• Listening to stakeholders• Being visible in the community• Always working to improve• Maintaining continuity through a

detailed QM Plan and documentation of meetings and activities

Contact Information• Eva B. Williams, MSN, FNP, MPH, AACRN

HIV Nurse Consultant – QM Team LeadPhone: (404) 657-3113Email: ebwilliams@dhr.state.ga.us

• Michael (Mac) Coker, MSN, RN, ACRNHIV Nurse Consultant Phone: (404) 463-0387Email: macoker@dhr.state.ga.us

• Pamela Phillips, BSW, MHA Quality Management Coordinator Phone: (404) 657-8993 Email: pmphillips@dhr.state.ga.us

65

Questions