HIV/AIDS Bureau Division of State HIV/AIDS Programs (DSHAP)
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Transcript of HIV/AIDS Bureau Division of State HIV/AIDS Programs (DSHAP)
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
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DSHAP Mission
To provide leadership and support to States/Territories for developing and ensuring access to quality HIV prevention, health care and support services.
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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
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Presenter
Heather HauckDirector
Division of State HIV/AIDS Programs
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Announcements & Updates
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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
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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
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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
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Questions
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A Review of DSHAP’s 2013 Webinars
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Respondents
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Number of Years in Position
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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%
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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
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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
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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
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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
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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)
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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%!
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:
• Develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to and quality of HIV services Improve
• Assess the extent to which HIV health services are consistent with the most recent Public Health Service guidelines for the treatment of HIV disease and related opportunistic infections; and
Evaluate
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?
For a Teaching Hospital (HIV case load: 700)
• Chief of Infectious Diseases
• AIDS Center Administrator• Director of Ambulatory
Care• Director of Quality
Improvement• Director of Nursing• AIDS Center Nurse
Practitioner• Clinic Coordinator for
Case Management• Senior Staff Nurse• Patient Representative• Part D Provider
For a Community Health Center
(HIV caseload: 100)
• Medical Director• Senior Staff Nurse• HIV Nurse• Case Manager• Patient Representative
For a Network (State jurisdiction)
(HIV case load: 20,000)
• Ryan White Program Coordinator
• State AIDS Director• Medical Director• Quality
Manager/Contractor• Medicaid • CDC Prevention• Part C or Part D contractor• Subcontractors (Case
Manager, housing, food bank, etc.)
• Patient Representative
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 statement2. Quality infrastructure3. Performance measurement4. Annual quality goals5. Engagement of stakeholders6. 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 StructureHIV Medical
AdvisorHIV Office Director
RW Part B Care
Manager
QM Team Lead HIV
Nurse Consultant
Quality Management Coordinator
HIV Nurse Consultant
Part-Time Data
Manager
HIV Prevention Manager
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 PlanCommunication &
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
2006 20090
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20
30
40
50
60
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90
100
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Cervical Cancer Screening Rates2006 and 2009 Clinical Chart
Reviews
Cervical Ca Screening Rate IHI Goal: 90%
Perc
ent
%
2006 20090
10
20
30
40
50
60
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80
90
100
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Dental Examination Rates2006 and 2009 Clinical Chart
Reviews
Dental Exam Rate IHI Goal: 75%GA RW Part B Goal: 50%
Perc
ent
%
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: [email protected]
• Michael (Mac) Coker, MSN, RN, ACRNHIV Nurse Consultant Phone: (404) 463-0387Email: [email protected]
• Pamela Phillips, BSW, MHA Quality Management Coordinator Phone: (404) 657-8993 Email: [email protected]
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Questions