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HIV/AIDS Bureau Division of State HIV/AIDS Programs (DSHAP) Ryan White HIV/AIDS Program Part B Technical Assistance Webinar Building a Quality Management.

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Presentation on theme: "HIV/AIDS Bureau Division of State HIV/AIDS Programs (DSHAP) Ryan White HIV/AIDS Program Part B Technical Assistance Webinar Building a Quality Management."— Presentation transcript:

1 HIV/AIDS Bureau Division of State HIV/AIDS Programs (DSHAP) Ryan White HIV/AIDS Program Part B Technical Assistance Webinar Building a Quality Management Program January 15, 2014

2 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 3 Agenda Opening Remarks/ AnnouncementsHeather Hauck Question and Answer Report on DSHAP’s 2013 WebinarsKatherine Patterson, Magnus Azuine The Ryan White HIV/AIDS Program Moving Forward – Quality Initiatives Heather Hauck Clinical Quality ManagementSusan Robilotto Georgia Quality Management ProgramEva Williams Questions and Answer Closing RemarksHeather Hauck

4 4 Presenter Heather Hauck Director Division of State HIV/AIDS Programs

5 5 Announcements & Updates

6 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 Ryan White RSR and ADR Submission Timelines Date RSR ADR GranteesProviders Monday, December 2, 2013RSR 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, :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, 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, 2014Return 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, :00 p.m. 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, :00 p.m. ET 2013 ADR is Due to HRSA

8 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 Deadline: March 10, 2014 System-level Workforce Capacity Building for Integrating HIV Primary Care in Community Healthcare Settings – Evaluation and Technical Assistance – HRSA Deadline: March 10, 2014 HRSA/HAB will host a technical assistance (TA) webinar Wednesday, January 29, 2014 from 2:00 – 4:00pm EST (HRSA ) and Thursday, January 30, 2014 from 2:00 – 4:00pm EST (HRSA ) Register

9 9 Questions

10 10 A Review of DSHAP’s 2013 Webinars

11 11 Respondents

12 12 Number of Years in Position

13 13 Topics of Interest Healthcare Reform in States28% 2013 Reauthorization24% National Monitoring Standards18% 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 14 DSHAP 2013 Webinars January 30, 2013ADAP and Federal PCIP Coordination February 13, 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, 2013National 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, 2014ADAP ERF 2014 FOA

15 15 NASTAD Cooperative Agreement March 2013ADAP Crisis Lessons Learned March 2013Financial Forecasting Part One May 2013Financial Forecasting Part Two May 2013ADAP and Health Reform June 2013ADAP and Insurance September 2013ADAP Application and Coordination with ACA October 2013Plan Assessment

16 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 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 PBMs Maintenance of Effort

18 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 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 Webinar Evaluation Option 1 Option 2

21 Building a Quality Management Program HAB Expectations Heather Hauck, MSW, LICSW Director Division of State HIV/ AIDS Programs

22 Objectives  HAB expectations for a Quality Management Program  Components of a Quality Management Program  Grantee Presentation


24 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.

25  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

26  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

27 Components of a Quality Management Program Susan Robilotto, D.O. Clinical Consultant Division of Metropolitan HIV/AIDS Programs Division of State HIV/AIDS Programs

28 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

29 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.

30 Components of a QM Program  Quality Infrastructure  Quality Management Plan  Performance Measures  Quality Improvement Projects

31 Quality Infrastructure  Infrastructure enhances systematic implementation of improvement activities. Infrastructure

32 Quality Infrastructure  Quality Management Committee  Leadership  Stakeholders

33 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

34 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

35 Leadership  Clearly articulated mission and vision statement  Ongoing measurement of performance  Ongoing assessment by leaders  Active coaching by leaders

36 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

37 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

38 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

39 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

40 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

41 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

42 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  asures.html asures.html

43 Quality Improvement Projects Imbalance Balance

44 Quality Improvement Projects PDSA Cycle

45 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

46 Quality Management Program Resources:  National Quality Center (NQC)  NQC Quality Academy  HIV/AIDS Bureau (HAB) Performance Measures easures.html

47 Georgia Department of Public Health Ryan White Part B Quality Management Program HRSA TA Webinar Building a Quality Management Program January 15, :00 – 4:00 PM

48 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

49 RW Part B QM Team Structure HIV Medical Advisor HIV 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

50 Part B-Funded Health Districts 1-1 Rome 1-2 Dalton 3-1 Cobb-Douglas 3-3 Clayton 3-4 East Metro 4-0 LaGrange 5-1 Dublin 5-2 Macon 6-0 Augusta 7-0 Columbus 8-1 Valdosta 8-2 Albany 9-1 Brunswick/Savannah 9-2 Waycross 10-0 Athens **3-2 Fulton and 3-5 DeKalb are funded primarily by Part A

51 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 : 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

52 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

53 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

54 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

55 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

56 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

57 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

58 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

59 CQI Project Data

60 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

61 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

62 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

63 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

64 Contact Information Eva B. Williams, MSN, FNP, MPH, AACRN HIV Nurse Consultant – QM Team Lead Phone: (404) Michael (Mac) Coker, MSN, RN, ACRN HIV Nurse Consultant Phone: (404) Pamela Phillips, BSW, MHA Quality Management Coordinator Phone: (404)

65 65 Questions

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