1. THE COMMONWEALTH FUND The Long-Term Quality Alliance and its Innovative Communities Initiative Mary Jane Koren, M.D., M.P.H. VP LTC Quality Improvement, The Commonwealth Fund mjk@cmwf.org Grantmakers in Health Annual Meeting March 8, 2012 With thanks to Pat Sprigg from Carol Woods in NC for some of these slides

2. THE COMMONWEALTH FUND What is the Long-Term Quality Alliance? Inaugurated in 2010 –A coming together of diverse stakeholders striving for balance between provider, consumer and other groups –First chair Mary Naylor, current chair Carol Raphael Purpose: To improve the effectiveness and efficiency of care and the quality of life of people receiving long-term services and supports by fostering person- and family-centered quality measurement and advancing innovative best practices. Initial focus: care transitions – from the LTSS side of the equation –Measurement Develop and test new measures or adapt existing measures Harmonize with other measures proposed or in use (AHRQ; NQF; NCQA) –Quality improvement Conduct pilots and demos to test or adapt proven practices Collaborate with existing QI organizations to support interventions and track data (QIOs, IHI, trade associations, others)

3. THE COMMONWEALTH FUND Why transitions? Nursing Home Assisted Living Rehabilitation Continuing Care Retirement Community Home County Council/ Department on Aging Area Agency on Aging Cooperative Extension Mental Health Provider Community Resource Connection Home Health Care Senior Center Adult Day Services Faith Community County Social Services ?

4. THE COMMONWEALTH FUND “If (re)hospitalizations are frequent, costly, and able to be reduced, why haven’t they been?” Challenges exist on multiple levels: Hospital-level barriers –Financial disincentives, no financial incentives, not high on priority list, limited knowledge / sharing of disease-specific efforts & care transition interventions among hospitals Community-level barriers –Not common to engage organizations across continuum of services to collaborate on improving care, lack of IT connectivity, no reimbursement for coordination & systems and organizations working in silos –We stay within the health care box and don’t look at the contextual issues, e.g. transportation, full-service grocery stores, housing, public safety, legal services and guardianship State-level barriers –Lack of population-based data, lack of understanding costs of poor quality on systems, effect of fragmented payer market and lack of CMS participation

5. THE COMMONWEALTH FUND The Innovative Communities Initiative Time is ripe: hospitals now have an incentive (as per the ACA) to collaborate with LTSS providers to improve transitions from one level of care to the next –Medicare to recover payments made to hospitals for unnecessary readmissions within 30 days of discharge beginning in October 2012 Delivery system change happens at the local level Community delegations of 3-5 individuals invited to attend the first LTQA Summit* (12/10) –Shared challenges and solutions –Explored participating in the ICI Collective action is required for lasting impact – it takes a community * Supported by the SCAN Foundation

6. THE COMMONWEALTH FUND Collective action to achieve collective impact* Collective impact initiatives represent ongoing commitments by key stakeholders from different sectors to a common agenda for solving a specific social problem Step 1: Assembling the components –Identify and develop a supporting infrastructure –Forge new partnerships across interest groups –Build strong working relationships among important players through continuous, ongoing communication –Concentrate on identifying and then addressing the common problem –Jointly agree on what success will look like and have a shared measurement system to track progress towards the goal –Use mutually reinforcing activities to maximize existing resources Step 2: Sustaining gains *Kania and Kramer, Collective Impact; Stanford Social Innovation Review, Winter 2011

7. THE COMMONWEALTH FUND Key Partners DHHS Community Connections Community Services Health Care Consumers ADRCs Policy CMS/AoA Communities across the US are beginning to consider transitions of care as a community –based challenge that requires shared ownership and close collaboration across settings. (Institute for Healthcare Improvement)

8. THE COMMONWEALTH FUND From Communication To Cooperation To Coordination To Collaboration Community Engagement is a journey, and, like any journey, it takes time

9. THE COMMONWEALTH FUND Lessons from the field: Listening to the LTQA’s Innovative Communities Identify a Change Agent Stakeholders: Consumers: Make the Case Encourage Collaboration: Public & Private Partnerships Build Synergy: But Keep Alignment Demonstrate Impact (Now vs. Future) Choose Intervention –Find the Fit-Don’t Duplicate Capture the Data – who/what/how/why Sustainability is Critical!

10. THE COMMONWEALTH FUND The role of LTQA Serve as a repository of information Propose and promote common definitions and terminology Be a coach and a convener for the communities Identify state and federal funds to assist the collaboratives Launch a consumer education campaign Educate public officials and lawmakers Advocate at the national level for flexibility to innovate Identify regulatory barriers to innovation

11. THE COMMONWEALTH FUND What can you do? Examine your foundations priorities – could they be furthered by the creation of an LTQA type Innovative Community? Discover what your community/region/state is already doing – lots of good things may be underway already but struggling and you can give them wings Convene Provide technical assistance; build infrastructure Give seed money Reward achievements But just DO something – don’t walk away because the long-term services and supports issues are big and complex Remember – The way to eat an elephant is one bite at a time! 11