1. 2003 Real Choice Grant: Update Quality Close to Home: Building Tools for Quality Assurance/Quality Improvement in Home & Community-Based Services

2. General Purpose of the Real Choice CMS Grants Provide funding to states to make significant, enduring changes to infrastructure supporting HCBS consumers Promote, promulgate “best practices” developed by states. Hot topics: consumer direction, quality mgmt/CQI, employment, relocation, family support, incidence management

3. MN’s 2003 Real Choice Grant Grant $ builds needed quality tools: VA Data Collection system VA Data Collection system Data Mart: mini-warehouse to integrate data from MMIS/EIS, county visits, investigative agencies, complaint offices, etc. Creates broader, deeper reports & analysis capacity Data Mart: mini-warehouse to integrate data from MMIS/EIS, county visits, investigative agencies, complaint offices, etc. Creates broader, deeper reports & analysis capacity Consumer survey: make sure we hear about quality of life and services from people supported under the programs Consumer survey: make sure we hear about quality of life and services from people supported under the programs Systems-generated communication to case managers, agencies Systems-generated communication to case managers, agencies Source of information to build provider profiles for MinnesotaHelp.info Source of information to build provider profiles for MinnesotaHelp.info

4. Broad Goals of 2003 Grant. Will support DHS quality management strategy developed for HCBS Support CQI in HCBS Will help address identified areas for improvement in quality management Ensure tools serve broadest purpose in quality assessment, measurement, and uses of findings Plan for public dissemination of findings: consumer uses Plan to ensure support when things need to be fixed (remediation) “So what” Identify barriers, challenges to completion of HCBS quality management objectives Coordinate consumer input Meet federal mandate under new QA framework

5. Minnesota’s HCBS Programs: AC, CAC, CADI, EW, MR/RC, TBI-NF, TBI-NB Share common eligibility criteria Share common quality assurance requirements Program areas each commit resources to quality assessment, improvement Makes sense to coordinate, target, ensure CQI loop = quality management strategy

6. Quality Management Diagram: Possible Activities

7. Grant Widens the Window of Opportunity -MinnesotaHelp.info: Provider profiles/report card: What do we/consumers want to know about quality of service or care, where/how information is collected, how to import it to MinnesotaHelp.info -Shared Master Index project: creates opportunity to identify people in VA report system. -Recaptures attention to quality strategy, performance measures, etc.

8. Focusing the Grant Minnesota needs: Well-integrated incidence management system Well-integrated incidence management system Complete, consistent information for quality measurement and improvement Complete, consistent information for quality measurement and improvement Interface between pertinent information systems Interface between pertinent information systems Better ways to link data to continuous quality improvement opportunities (program and policy development) Better ways to link data to continuous quality improvement opportunities (program and policy development)

9. Improving QA/QI Design Ability to identify individuals in HCBS in non-MMIS data bases is limited Efficient QA/QI design given resources Ensure QA efforts support achievement of state goals as well as federal compliance: develop QA/QI plan, tools for Minnesota Indicators at various levels: program, consumer, county, provider, population

10. Consumers & Quality Info about quality that would support consumer choice- making: provider profiles, e.g. Strategy and products to communicate quality findings to public Quality of life/care indicators that matter to people supported under the programs Requires ongoing consumer input: QDC

11. Vulnerable Adult Report Data System Product Details Evaluates use of SSIS for county VA/AP data submission Extracts data from counties with mature databases Will improve consistency, completeness of report data 8 volunteer counties to build, test HIPPA compliant (paper submission of sensitive data at present)

12. VA Report Data Collection Product Details Provide comprehensive and consistent VA Report data that can form the basis of remediation strategies and targeted improvement efforts. Provide a more complete picture of locally investigated reports (about 40% of all reports).

13. Vulnerable Adult Report Data System Product Details Allows individuals to be identified with creation of Shared Master Index, VA Report identifier Allows individuals to be identified with creation of Shared Master Index, VA Report identifier Systems-generated communication with case managers, agencies Systems-generated communication with case managers, agencies Help us identify trends, target TA Help us identify trends, target TA Will be critical for CDCS health/safety Will be critical for CDCS health/safety

14. Consumer Input into QA/QI: Product Details Ombudsman volunteers help pilot, retest tool, conduct ongoing surveys Pilot EW survey tool is done, ready for testing. Added measures related to social roles, relationships, need some for consumer directed, caregivers, consumer outcomes to be collected on all HCBS at assessment/reassessment in MMIS Quality Design Commission: consumer input into survey work, indicators work, plan for dissemination of QA findings

15. Data Mart Product Details Quality Data Mart: A place to store & analyze quality data Integrates existing data bases Integrates existing data bases Interfaces with EIS and MMIS as well as Licensing, MDH, Appeals, Ombudsman, e.g. Could also store non-MMIS data (e.g. Licensing review information, MH data) Interfaces with EIS and MMIS as well as Licensing, MDH, Appeals, Ombudsman, e.g. Could also store non-MMIS data (e.g. Licensing review information, MH data) Can be supported within the existing IT environment Can be supported within the existing IT environment

16. Data Mart Product Details Will house data from VA Report System, County Assessment Visits, Consumer Surveys, extracted data from other relevant sources (MDH, eg) Can be created with several levels of secured access: county reports, management/division, ad hoc Would be source of HCBS provider profile information for MinnesotaHelp.info

17. Successful Project Can Help Minnesota: Improve incidence management Make best use of QA/QI resources Coordinate quality activity into a quality management strategy Respond to Elder Justice Act that will require nat’l reporting of abuse of elders

18. Successful Project Can Help Minnesota: Offer different QA/QI strategy, tools, measures for consumer directed service options Develop data driven CQI, program eval Develop better public dissemination of quality information/findings, including provider profile information Meet federal compliance with new HCBS QA framework

19. Work Plan & Timeline Business Analysis contract: hired effective June 9 th. Data mart design specs, VA data collection method & specs (includes review of other states): Dec, 2004 EW Consumer Survey: Pilot version completed, surveys will start mid-July Random statewide EW survey: wtr/sp, 2005 VA work group: 8 counties, finalizing forms data & process requirements QA/QI data mart built: July, 2005 VA Reporting System on line: Sept 2005

20. View of QA/QI Data Mart

21. MMIS /EIS MAXIS (Health Match) Other... License Reviews, HwServices Registry Info, Ombudsman Data Data Sources SSIS Education Employment Health Housing Corrections Courts Social Services Health Care Family Support Institutional/Residential Quality Data Mart Dept of Economic Security Dept of Health Investig & Other Potential Data Relationships for Quality Data Mart VA Data

22. Federal Assurances in MA-Funded HCBS http://www.cms.hhs.gov/medicaid/waivers/frameworkmatrix The Matrix: Handout Outlines domains that states must address in program & quality design Outlines domains that states must address in program & quality design Outlines expected outcomes Outlines expected outcomes Outlines primary functions of state monitoring and oversight Outlines primary functions of state monitoring and oversight Emphasizes the need for continuous quality improvement mechanisms Emphasizes the need for continuous quality improvement mechanisms Focuses on consumer input in the quality design Focuses on consumer input in the quality design