Presentation on theme: "HIV/AIDS Bureau Division of State HIV/AIDS Programs (DSHAP)"— Presentation transcript:
1HIV/AIDS Bureau Division of State HIV/AIDS Programs (DSHAP) Ryan White HIV/AIDS Program Part B Technical Assistance WebinarBuilding a Quality Management ProgramJanuary 15, 2014
2DSHAP MissionTo provide leadership and support to States/Territories for developing and ensuring access to quality HIV prevention, health care and support services.
3Agenda Opening Remarks/ Announcements Heather Hauck Question and AnswerReport on DSHAP’s 2013 WebinarsKatherine Patterson, Magnus AzuineThe Ryan White HIV/AIDS Program Moving Forward – Quality InitiativesClinical Quality ManagementSusan RobilottoGeorgia Quality Management ProgramEva WilliamsQuestions and AnswerClosing Remarks
4Heather Hauck Director Division of State HIV/AIDS Programs PresenterHeather Hauck Director Division of State HIV/AIDS Programs
6Announcements 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
72013 Ryan White RSR and ADR Submission Timelines DateRSRADRGranteesProvidersMonday, December 2, 2013RSR Grantee Report Start DateSystem opens for grantees to begin work on their RSR Grantee Report.Monday, January 6, 2014RSR Provider Report Start DateSystem opens for providers to begin work on their RSR Provider Reports and upload their client-level data files.Monday, February 3, 20146:00 p.m. ESTRSR Grantee Report due dateAll 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, 20142013 ADR Client XML Test Site OpensMonday, March 10, 2014Target 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 deadlineLast day for grantees to return RSR Provider Reports and client-level data to their providers for changes or corrections.Monday, March 31, 20146:00 p.m. ETAll RSRs must be in “Submitted” status by 6:00 PM ET.Thursday, April 10, 2014ADR Web System Opens for 2013 Data CollectionMonday, June 9, 20142013 ADR is Due to HRSA
8New SPNS FY 14 FOAs Released: System-level Workforce Capacity Building for Integrating HIV Primary Care in Community Health Care Settings – Demonstration sites HRSADeadline: March 10, 2014System-level Workforce Capacity Building for Integrating HIV Primary Care in Community Healthcare Settings – Evaluation and Technical Assistance – HRSAHRSA/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
10A Review of DSHAP’s 2013 Webinars I would now like to briefly review the TA webinars completed by the division for CY 2013.In November of CY 2012, we solicited feedback from Ryan White HIV/AIDS Program Part B Grantees on the division’s technical assistance webinars by asking grantees to complete the 2013 Technical Assistance Webinar Content Request which included a series of 10 questions. The results from the content request were presented in a webinar for Part B grantees on February 13, 2013 entitled “The 2013 Technical Assistance Webinars Feedback and Part B Program Updates”.
11RespondentsThere were a total of 51 respondents who completed the content request; the majority were State HIV/AIDS RW Part B Program Coordinators
12Number of Years in Position Interesting to note that the majority of respondents (34%) had been in their position only one year or less
13Topics of Interest Healthcare Reform in States 28% 2013 Reauthorization24%National Monitoring Standards18%Early Intervention Services and working with CDC/ ADAP Eligibility, Enrollment and recertification6%National HIV AIDS Strategy/ HAB Performance Measures/Quality Management Plans/Insurance continuation through ADAP4%Maintenance of Efforts/Pharmacy Benefits Management overview and how to work with PBMs2%One of the key questions grantees were asked to rank a list of topics from most to least important based on their interests. Healthcare Reform, the 2013 Reauthorization of the Ryan White legislation and the National Monitoring Standards were the highest ranked topics.So how did we do as a division?
14DSHAP 2013 Webinars January 30, 2013 ADAP and Federal PCIP CoordinationFebruary 13, 20132013 TA Webinars Feedback and Part B Program UpdatesMarch 26, 2013Clarifications on Client Eligibility Assessment and Recertification RequirementsApril 30, 2013Carryover Requests and Federal Financial Reports (FFR): Tracking and Reporting of RebatesJune 11, 2013National Monitoring Standards Update and Schedule of ChargesJune 26, 2013FY 2013 Part B Supplemental Funding Opportunity Announcement (FOA) and the ADAP ERF FOAOctober 10, 2013FY 2014 Ryan White HIV/AIDS Program Part B /ADAP Earmark Funding Opportunity AnnouncementOctober 31, 2014ADAP ERF 2014 FOAIn CY 2013 the following webinars were completed by the division meeting our goal of providing two technical webinars per quarter
15NASTAD Cooperative Agreement March 2013ADAP Crisis Lessons LearnedFinancial Forecasting Part OneMay 2013Financial Forecasting Part TwoADAP and Health ReformJune 2013ADAP and InsuranceSeptember 2013ADAP Application and Coordination with ACAOctober 2013Plan AssessmentThrough the 2013 cooperative agreement with HIV/AIDS Bureau, the National Alliance of State and Territorial AIDS Directors (NASTAD) provided seven additional technical assistance webinars covering the following topics
16Other HAB Sponsored Webinars August 14, 2013; “Preparing for 2014: Overview of Ryan White HIV/AIDS Part B Program policy updates and guidance” sponsored by HABAugust 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 HRSANovember 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 BureauThere were also four additional webinars provided to Ryan White HIV/AIDS Part B grantees sponsored by the Health Resources and Services Administration (HRSA), the HIV/AIDS Bureau in partnership with the Centers for Medicaid and Medicare Services (CMS) to prepare grantees for implementation of the Affordable Care Act and assisting clients with enrollment into the Marketplace.Aug 14, 2013 Policy update topics:Outreach, Enrollment and Benefits CounselingClarifications Regarding Medicaid-Eligible Clients and Coverage of services by Ryan White HIV/AIDS ProgramsClarifications on Ryan White Programs Client Eligibility Determinations and Recertification RequirementsFederal Register Notice: Ryan White HIV/AIDS Program Core Medical Services Waiver application requirements
17Grantee Topics Completed Healthcare Reform in States2013 ReauthorizationNational Monitoring StandardsEarly Intervention Services and working with CDCADAP Eligibility, Enrollment and recertificationNational HIV AIDS StrategyQuality Management PlansInsurance continuation through ADAPHAB Performance MeasuresPharmacy Benefits Management overview; how to work with PBMsMaintenance of EffortThe division was able to address many (54%) of the grantee’s topics of interest through the quarterly technical assistance webinars or through webinars provided in partnership with the bureau or cooperative agreements with our partners.
18Additional Topics Cap on charges & sliding fee scales Role of case managers in outreach and enrollment in MarketplaceImpact of ACA on Ryan WhiteRyan White Services ReportImplementation of insurance continuation programs & ACAQuality Management PlansADAP Data Report (ADR)The following additional topics recommended by grantees in the webinar content request were also addressed last year.
19How Did We Do? The division met and exceeded it’s goal 54% of grantee topics addressedA total of 19 technical assistance webinars completed. An increase of 130%!The Division of State HIV/AIDS Programs met and exceeded its goal of providing two technical assistance webinars every quarter. The division facilitated a total of nineteen (19) technical assistance webinars in calendar year This is an increase of more than 130% compared to the 8 webinars (two per quarter) established as the target by the DSHAP management team
202014 Webinar Evaluation Option 1 Option 2 Kpatterson@hrsa.gov FY2012 carryover funds will be applied to FY 2014.
21Building a Quality Management Program HAB ExpectationsHeather Hauck, MSW, LICSWDirectorDivision of State HIV/ AIDS Programs
22Objectives HAB expectations for a Quality Management Program Components of a Quality Management ProgramGrantee Presentation
23We know that we provide multiple layers of value within HAB and the RW program. Most obviously, we provide funds for service delivery- that basic public health function of assurance of services.
24Zero New InfectionsThe 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.HAB facilitates improvements in HIV care through a continuum of quality HIV care for low-income individuals and families to reduce new HIV infections, to improve health outcomes for PLWH from diagnosis to achieve optimal treatment, and to reduce HIV-related health disparities.HAB leadership and staff continually assess the HIV care and service needs of PLWH via grantee/provider monitoring and oversight, client feedback, implementation of special studies and collaborative activities within HHS OPDVIS and other federal agencies.HAB leadership and staff provide expertise regarding HIV policy and consideration for the medically underserved on Federal care and treatment guidelines.In conjunction with Ryan White grantees and providers, HAB assesses models of care and services required for care completion with insight from the implementation of Special Projects of National Significance.Targeted training of the health care workforce through curriculum development, mini-residency experience to promote the adoption of HIV/AIDS care as a chronic illness.Training, dissemination and replication of effective models of care inclusive of medical homes to Ryan White and other clinical providersHAB staff provides leadership on national HIV/AIDS quality measures by the development, alignment among HHS OPDIVS and other federal agencies and adoption of these measures Ryan White clinical providers.
25QualityEmpower 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.
26QualityHAB 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.
27Components of a Quality Management Program Susan Robilotto, D.O.Clinical ConsultantDivision of Metropolitan HIV/AIDS ProgramsDivision of State HIV/AIDS Programs
28Ryan 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 servicesImproveAssess 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; andEvaluate
29Programmatic 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; andIncorporated quality-related expectations into Requests for Proposals (RFP) and contracts.
30Components of a QM Program Quality InfrastructureQuality Management PlanPerformance MeasuresQuality Improvement Projects
31Quality Infrastructure Infrastructure enhances systematic implementation of improvement activities.InfrastructureThe infrastructure is the base on which the QM program is built. A solid base insures that the rest of the program can be built and maintained.
32Quality Infrastructure Quality Management CommitteeLeadershipStakeholdersTouch on 3 important parts of the infrastructure: the QM committee, leadership and stakeholders.
33Quality Management Committee Builds the HIV program’s capacity and capability for quality improvementInvolves program leaders and other key staff to cement their personal commitment to qualityIn a large organization, links the HIV quality program with the organization’s overall quality programThe quality management committee leads the HIV program’s quality improvement activities. Its job is to build the program’s capacity and capability for improvement.The committee should include leaders from different areas of your HIV program and their involvement in the committee’s work will help strengthen their personal commitment to quality as well.If your HIV program is part of a larger organization, you will want to coordinate your quality improvement work with that of your organization as a whole. The quality management committee helps to do this.
34Who might be on the committee? For a Teaching Hospital (HIV case load: 700)Chief of Infectious DiseasesAIDS Center AdministratorDirector of Ambulatory CareDirector of Quality ImprovementDirector of NursingAIDS Center Nurse PractitionerClinic Coordinator for Case ManagementSenior Staff NursePatient RepresentativePart D ProviderFor a Community Health Center (HIV caseload: 100)Medical DirectorHIV NurseCase ManagerFor a Network (State jurisdiction)(HIV case load: 20,000)Ryan White Program CoordinatorState AIDS DirectorQuality Manager/ContractorMedicaidCDC PreventionPart C or Part D contractorSubcontractors (Case Manager, housing, food bank, etc.)Here are examples of what a QM committee may look like. These include the examples of a teaching hospital and a health center to illustrate how a State with small numbers of cases may think about structuring a QM committee.
35Leadership Clearly articulated mission and vision statement Ongoing measurement of performanceOngoing assessment by leadersActive coaching by leadersOrganizations with strong capabilities in data and measurement have clearly articulated mission and vision statements with ongoing measurement of performance that links to the mission and the vision. They have ongoing assessment by leaders of quantitative performance measures and a clear method for leaders to use to prioritize and select processes on which to focus and improve. It’s also imperative to have active coaching by leaders of performance improvement teams.
36StakeholdersHow will staff, providers, consumers and others be involved in the CQM program?Engage internal and external stakeholdersCommunicate information about quality improvement activitiesProvide opportunities for learning about qualityA strong QM program involves stakeholders. Stakeholders have different perspectives on improving HIV programs and care. Clinicians focus on technical aspects of quality HIV care, whereas consumers focus is on experience of receiving care. Involvement of all stakeholders builds a strong system of care.
37Quality 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 FY14The quality management plan is the written document describing how the quality management program works, what gets done, who does it and how. These are all spelled out, in writing, in the quality management plan.
38Quality Management Plan of a Quality Management Plan Quality statementQuality infrastructurePerformance measurementAnnual quality goalsEngagement of stakeholdersEvaluationThe quality management plan should contain the six elements listed here. Keep in mind that the QM Plan should be viewed as a living document that is evaluated and updated on a regular basis. It is not something that is “checked off the list.”
39The 10 QM Plan RulesDo not reinvent the wheel, use established frameworks to get started‘Steal Shamelessly, Share Senselessly’Size does not matter80% planning, 20% writing (old software programming rule)A few visionary annual goals are better than plenty of useful onesSample plans are out there. Use the references at the end of this Tutorial to find them, and begin there.As with so many things in quality, make use of what others have done and be willing to share what you’ve accomplished, to help others.It doesn’t matter how long it is. Substance matters more.Think through what you want to do before you start to write. Don’t obsess over the writing, it’s the planning that matters.Use the plan-writing process to push your organization forward.
40The 10 QM Plan Rules (cont.) 6. Be inclusive, even if it takes longer to get your final QM planIf you have not touched your plan in the last 6 months, bring it to the next quality committee meetingA perfect plan is never writtenPlans are only as good as their implementationGet startedInvolve the people who need to be involved. They will make the plan a living document, rather than something that’s just a hoop to be jumped through.Here’s a tip to make sure your plan stays real – if you’re not using it regularly, haul it out and talk about it. It should be a living guide.Don’t let the perfect be the enemy of the good. If it works for your organization, it’s fine.Plans are only as good as their implementation.To use a popular cliché, just do it! All the planning in the world is for not if you do not take action.
41Performance Measures Importance of Performance Measures: Separating what you think is happening from what is really happeningEstablishing a baseline and allowing for periodic monitoringDetermining whether changes lead to improvementsComparing performance with othersLinking performance data to quality improvement activitiesMeasuring HIV performance data helps us in many ways. We can separate what we think is happening from what is really happening and then establish a baseline and allow for periodic monitoring. From here, we can determine whether changes lead to improvements or not. It is equally important to compare performance across sites, and finally, link performance data to quality improvement activities.
42HAB Performance Measures 2007: Started developing and releasing measures under the guidance of Dr. CheeverCurrently 46 measures spanning clinical care, oral health care, ADAP, case management, and systemsAlignment and streamline measure across federal programsCore measures received National Quality Forum endorsement in February 2013asures.htmlWHAT DO WEWANT TO ACHIEVE?Emphasize Priorities- across the HIV Care ContinuumAlignment with Other Federal Stakeholders-Parsimony
43Quality Improvement Projects ImbalanceBalanceMany grantees are measuring data but are lacking the next part of the QM program, the quality improvement part. Performance measurement alone is not quality improvement. However, to do quality improvement, you need performance measurement.
44Quality Improvement Projects PDSA CycleThere are different methods for developing quality improvement projects. One of the most commonly used is the Plan-Do-Study-Act cycle. The PDSA cycle is an effective model for developing short term quality improvement initiatives. The NQC website has a tutorial on the PDSA cycle.
45Quality Management Program QM Program evaluation toolDeveloped to help project officers and consultants to better evaluate QM Programs during site visitsIdentify if a program is meeting legislative requirementsIdentify 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 careUpdated QM plans are going to be requested from all Part B grantees within the next year.
46Quality Management Program Resources:National Quality Center (NQC)NQC Quality AcademyHIV/AIDS Bureau (HAB) Performance Measureseasures.html
47Georgia Department of Public Health Quality Management Program Ryan White Part BQuality Management ProgramHRSA TA WebinarBuilding a Quality Management ProgramJanuary 15, 20143:00 – 4:00 PM
48Acknowledgments Rosemary Donnelly, SEATEC Clinical Director Pamela Phillips, RW Part B QM CoordinatorMichael Coker, RW Part B HIV Nurse ConsultantRachel Powell, RW Part B QM Data ManagerMarisol Cruz, RW Part B Care ManagerWilliam Lyons, HIV Office DirectorKim Brown, HRSA Project OfficerRW Part B QM Core Team and SubcommitteesNational Quality CenterRW Part B-funded health district staffRepresentatives/Grantees of other Georgia RW Parts
49RW Part B QM Team Structure HIV Medical AdvisorHIV Office DirectorRW Part B Care ManagerQM Team Lead HIV Nurse ConsultantQuality Management CoordinatorHIV Nurse ConsultantPart-Time Data ManagerHIV Prevention Manager
50Part B-Funded Health Districts RomeDaltonCobb-DouglasClaytonEast MetroLaGrangeDublinMaconAugustaColumbusValdostaAlbanyBrunswick/SavannahWaycrossAthens**3-2 Fulton and 3-5 DeKalb are funded primarily by Part A
51Origins of the QM Program 1990’s: Nurse consultant for HIV Prevention asked to assist with quality reviews for medical careHIV Medical Advisor hired 20002005: Title II Collaborative with HRSA/NQC18 months of TA and supportDeveloped written QM PlanCreated statewide QM CommitteeAdditional QM staff hiredImproved buy-in from all stakeholders
52Elements of Current Structure Georgia RW Part B Program QM PlanStatewide QM Core Team and SubcommitteesExpectations for funded health districtsData Collection, Reporting and Analysis
53Georgia RW Part B QM Plan Communication &CoordinationQM Core Team &SubcommitteesContinuousQuality Improvement(CQI) ProjectsEvaluationData CollectionLocal QM Plans &Annex-GIACapacity Building(Training and TA)Part BQM Plan
54Georgia RW Part B QM Plan Implemented April 1 – March 31, updated annuallyProcess to evaluate and revise:Meetings with stakeholdersReview quality dataNQC AssessmentsFederal initiativesApproval by QM Core Team and HIV Office Director prior to implementation
55Statewide RW Part B QM Core Team Purpose: To provide oversight and facilitation of the GA RW Part B QM PlanMeetings are held quarterly, face-to-face preferred in a central location for the stateComposed of multidisciplinary professionals and consumersSubcommittees: Case Management, ADAP/HICPCollaboration with other RW Parts
56Funded Health District QM Expectations Ensure compliance with DHHS-related guidelinesParticipate in statewide Part B QM ProgramDevelop and implement local QM ProgramWritten QM Plan and work plan updated annuallyLeader and team to oversee the ProgramQM Goals, objectives and strategiesCommunicate results to all levels of the organization, including consumers as appropriate
57Quality Data Collection and Reporting Collaborate with Epi/SurveillanceSurveys, e.g. statewide Client Satisfaction SurveyClinical and Case Management Chart ReviewReliableLimitations in how the data is collectedTime and resource intensiveCAREWareUniform comparison based on data that is enteredIncludes all eligible clientsGenerally less reliable for some measures and districts
58Overview of a CQI Project Clinical chart reviews were conducted in 2006Two areas of improvement were found: dental exam and cervical cancer screeningDistricts not at goal were asked to incorporate these measures into their local QM PlansImprovement projects occurred at both the state and local levelsIn 2009, clinical chart review showed modest improvement in both measuresCurrently, clinical chart review data is being analyzed for CY The data will be compared with 2006 and 2009 to determine trends and next steps
60Recent Projects Statewide client satisfaction survey In+Care Campaign Collaboration with MedicaidCase Management Acuity Scale and Self Management ModelADAP/HICP CAREWare electronic application processProviding quality-related trainings and technical assistance
61Challenges/Opportunities for Improvement Time frame for reporting data back to stakeholdersInnovative ways to improve CAREWare data entryCase management training disparityTechnical capacity
62Building a Program: Where to Begin? National Quality Center trainings and TAPeer learningObtaining buy-in from senior leadership and stakeholdersUsing tools from NQC outlining what a quality program should look likeWritten QM PlanQM CommitteeProcess for data collection and reporting
63Keeping the Program Strong National Quality Center Trainings and TABuy-in is an ongoing processDemonstrating the value of quality workListening to stakeholdersBeing visible in the communityAlways working to improveMaintaining continuity through a detailed QM Plan and documentation of meetings and activities