Embed Size (px)
Citation preview
Measures for SNPs Enrolling Adults with Disabilities
Susan E Palsbo, PhDGMU Center for Health Policy, Research & Ethics
Margaret F. Mastal, PhD, RNDelmarva Foundation for Medical Care
Who are People with Disabilities?
• About 20% of the population
• 70% under age 65 (nearly 38 million).
• Emotional, behavioral, physical, sensory, developmental
• Often have more than one type of disability
• Severity measured by the ICF (World Health Organization)
Who Pays for Them?
• 55% - private health insurance
• 22% - Medicaid (non-institutionalized)
• 15% - uninsured
• 8% - Medicare– 6 million
• Numbers are increasing
• Costs are increasing more rapidly than their numbers
What is Their Experience with Health Care?
• Not good.• Huge access disparities.
–Especially for primary and preventive care.
–Disparity varies with disability type
Disability SNPs
• person-centered
• patient-driven
• proactive
• interdisciplinary care coordination– Nurses – Social workers
Challenges to Developing Quality Measures for ICCP SNPs
• Incomplete data
• Different populations
• Different scope of services
• Different intensity of service
• Different levels of sophistication in measuring and monitoring quality
Strategy for Identifying Measures
Identify measures appropriate to the population from measures that are already used by MCOs, the Veterans Administration, and/or Medicaid and Medicare programs.
•Comparisons external to SNPs: Can be compared against a group of people not in coordinated care. •Comparisons between SNPs: Confident that differences in numbers are not an artifact of computing numbers differently.•Acceptability: Existing measures have some currency as being “appropriate”.•Cost: It may be possible to purchase computer programs from a HEDIS® certified vendor or to use programs it already owns to generate the measures
General Criteria for Measures
1. Relevant
2. Scientifically strong
3. Feasible
4. Differentiate among delivery systems
5. Stimulate continuous quality improvement
Supplemental Criteria
1. Outcomes indicating good care coordination.
2. Available measures in general population.
3. Scalable.
4. Indicators of system breakdowns.
CommunityRethink Medical Necessity policies
Enhance accessibility of community resources
Health System
Self-management support
Clinician support
Delivery system design
Clinical information systems
6. Disability competency training.7. Clinical competency support.8. Technology assistance support.
9. Health education and behavioral modification.10. Accessible websites.
1. Gate-opening standard operating procedures.2. Disability-accessible providers.3. Extended appointments.4. Holistic services.5. Manage the need, not the benefit.
11. Comprehensive information system that manages and supports care coordination and quality improvement.
Informed, motivated individual
Prepared health coordination team of
nurses, social workers, mental and physical
health
Productive Interactions
Improved Outcomes
Disability Appropriate Care Model
ASPE1. Creating a System with the Right Capacities2. Providing Access to Needed Services3. Supporting Member Involvement in Decision Making and
System Improvement4. Resolving Problems and Concerns5. High Quality Interpersonal Interactions Between Members and
Providers6. Using Preventive Services to Keep Members Healthy and
Functioning7. Coordinating and Integrating Medical and Non-Medical Services8. State of the Art Treatments9. Improving the Outcomes of Care
Sofaer S, Woolley SF, Kenney KA, Kreling B, Mauery D. “Meeting the Challenge of Serving People with Disabilities: A Resource Guide for Assessing the Performance of Managed Care Organizations.” Report to ASPE. July 1998.
AHRQ
• CAHPS™ - People with Mobility Impairments
• Adopted ASPE domains
• Added – independent living – community participation– trust– education in self-management– self-directed care
Surveying People with Disabilities
• NIDRR and CDC have funded studies on the best ways to survey PWD
• Deaf
• Computer-assisted personal interviews
• NIH– IRT for questions on pain, cancer
management, etc
Nationally-Used Preventive Care Measures (examples)
Annual comprehensive health assessment % of members
Annual Chlamydia % sexually active participants.
Annual digital rectal exam to screen for colorectal cancer
% of members
Discuss tobacco use, smoking cession, use of seat belts
% of members
Annual Depression screen (more often may be appropriate)
% of members
Bone mineral density(at least once to determine risk)
% of men, % of women
Community IntegrationProgram responsiveness to consumer needs
% of participants reporting involvement in planning, design, delivery and evaluation of services.
Client-driven services and support
% of participants reporting active participation in treatment decisions; % of participants reporting they receive information to make informed choices.
Community tenure Length of time living in community; length of time in jail.
Substance abuse Number of days drinking/drug abuse in a defined time period.
Financial well-being People moving off SSI because they have stabilized and gained a job.
Prevalent Secondary Conditions
Asthma % of participants with an asthma action plan (AAP); % of participants and physicians complying with the national asthma guidelines
Depression Major depressive disorder (MDD): percentage of patients aged 18 years and older with confirmed diagnosis of major depressive disorder who had a suicide risk assessment completed at each visit. (AMA)
Diabetes DQIP measures
Chronic Condition Measures
Pressure ulcers % of members with pressure ulcers with periodic documentation on status of the characteristics of wound (e.g., size, depth, color, induration, odor, discharge).
Source: American Medical Directors Association
UTI % of members with bladder incontinence who have a UTI Source: CMS Nursing Home Measure
Pain management % of members with documented assessment using standardized tool at each reported change of condition requiring MDS notation
Source: American Medical Directors Association
Cost and Utilization Measures
• Care/case management, including participant education– Number and hours of contact per month, stratified by service
intensity
• Durable Medical Equipment Cost– utilization; repairs (HCPCS coding)
• Missed appointments– % of appointments that participant misses
• Personal care assistance – Cost; hours
• PharmacyCost; – prompt refills; – evidence-based and appropriate medication management
Reporting
• Report in formats and “dosage” that people with different disabilities can process
• Comparative report cards and intelligent decision-making tools
• NIDRR is funding several 5-year grants to explore this– Rehabilitation Institute of Chicago– George Mason University
Funding
• National Institute on Disability and Rehabilitation Research, US Dept. of Education, Grant # H133B70003, Grant # H133A030804
• Center for Health Care Strategies Grant #99906
Contact
Sue Palsbo, PhD
Peg Mastal, PhD, RN
