NHDP Quarterly Meeting Performance Improvement Projects September 30th, 2010 Presenters: Don Grostic, MS Associate Director, Research and Analysis Yolanda Strozier, MBA Project Manager, State and Corporate Services

Performance Improvement Projects -IMPROVEMENT-  Plans now familiar with validation requirements  Emphasis on improving outcomes 2

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Four Reasons PIP Outcomes Don’t Improve 4

Rates are already at a very high level Example:  The baseline rate exceeds the goal and/or benchmark Suggestion:  Analyze historical data before identifying PIP topics or study indicators  Make certain the performance can be improved 5

Barriers are not specific Example:  Barrier – Lack of knowledge (members and/or providers) Suggestion:  Identify the specific knowledge gap  Member lacks knowledge regarding the purpose of an advanced directive 6

Interventions are not specific to the PIP study timeline Example:  Interventions have been ongoing for multiple years and rates remain suboptimal Suggestion:  Ensure that new strategies are implemented during the study  Interventions prior to Baseline are potentially ineffective 7

Intervention’s success cannot be evaluated Example:  The plan documented 20 different interventions Suggestion:  Develop targeted interventions  Reduce the overall number of interventions  Ensure interventions are synergistic  Incorporate evaluation of the interventions 8

Data Drives the Improvement Process 9

Key Improvement Concepts  Know the rates for applicable demographic subgroups  Prioritize barriers; all barriers do not have to be addressed  Strategize interventions and intervention types based on barrier analysis  Identify an evaluation plan for each intervention prior to implementation  Submit supporting documentation for the entire improvement process 10

NHDP Preliminary Baseline Results for Timeliness of Services, SFY 2008–2009* Study Indicator Plan A Pan B Baseline NRateN 1) The percentage of eligible NHDP members who received home health services, adult day health, or home-delivered meals: a) Within 3 calendar days from the effective date of enrollment % % b) Within 5 calendar days from the effective date of enrollment % % c) Within 7 calendar days from the effective date of enrollment % % d) Within 10 calendar days from the effective date of enrollment % % 2) The percentage of eligible NHDP members who received home health services: a) Within 3 calendar days from the effective date of enrollment % % b) Within 5 calendar days from the effective date of enrollment % % c) Within 7 calendar days from the effective date of enrollment % % d) Within 10 calendar days from the effective date of enrollment % % 3) The percentage of eligible NHDP members who received adult day health: a) Within 3 calendar days from the effective date of enrollment %1471.4% b) Within 5 calendar days from the effective date of enrollment % % c) Within 7 calendar days from the effective date of enrollment % % d) Within 10 calendar days from the effective date of enrollment % % 4) The percentage of eligible NHDP members who received home-delivered meals: a) Within 3 calendar days from the effective date of enrollment %8048.8% b) Within 5 calendar days from the effective date of enrollment % % c) Within 7 calendar days from the effective date of enrollment % % d) Within 10 calendar days from the effective date of enrollment % % * Baseline results were not required of the NHDPs for the current validation year; preliminary results were not validated. Collaborative Baseline Results Submitted FY

I. Activity IX: Report improvement. Enter results for each study indicator, including benchmarks and statistical testing with complete p values, and statistical significance. Time Period Measurement Covers Baseline Project Indicator MeasurementNumeratorDenominator Rate or Results Industry Benchmark Statistical Test Significance and p value Quantifiable Measure 1: Baseline - 1a Baseline - 1b Baseline - 1c Baseline - 1d Quantifiable Measure 2: Baseline - 2a Baseline - 2b Baseline - 2c Baseline - 2d Note - Repeat for each study indicator Collaborative Baseline Results Submission October 8,

Intervention Strategies Worksheet Member Interventions What Makes Them Effective Barriers Telephone outreach within 2 business days  Identify immediate needs and confirm demographics  Timely referral  Incorrect demographics Conduct orientation visit 5 or more days prior to the effective date of enrollment  Time to conduct effective assessment to generate care plan to provide services timely  Family unavailable  Member unavailable  Untimely referrals from CARES CM telephone outreach to verify services are in place  Verification of service  Available staff due to enrollment management Educate member/care giver to call to verify authorization services are in place for start date  Verification of services  Safety net  Diminished capacity Implement care plan  Able to tell that the member is receiving services  Member unavailable  Untimely referrals from CARES Timeliness of Services Collaborative PIP June 2010 Quarterly Meeting 13

Intervention Strategies Worksheet Provider Interventions What Makes Them Effective Barriers Reviewing contracts and ongoing education with providers and setting expectations.  Provider knows expectations  Staff time to find point person Storing frozen foods in local area.  Accessible to providers  Timely delivery to enrollees  Find appropriate environment for storing food Modify authorization form to meet or highlight expectations.  Collaborative group modifies form  Makes expectations clear  Education Audit documentation (logs). Joint meeting with providers.  Keeps the providers in check  Members will need to share information/complaints  Staff time (training, primary source verification) Follow-up calls with providers after sending faxes (develop fax back form).  Confirm fax is clear and that the right person received the fax  Time to make the calls Timeliness of Services Collaborative PIP June 2010 Quarterly Meeting (cont.) 14

Intervention Strategies Worksheet System Interventions What Makes Them Effective Barriers Authorizations are sent to provider prior to start date.  Written confirmation with receipt  Was it staffed timely and appropriately? Billing procedures utilized.  In real time  Claims aren’t as timely Implement electronic medical record enabling.  Legible  Timely  Eliminating handwritten data entry error ASO, care plan, and claims payment system.  Quicker adjudication  More centralized  Integrate system  Claims lag behind integration E-fax service authorizations.  Not manual  No real time proof service was delivered at that time Timeliness of Services Collaborative PIP June 2010 Quarterly Meeting (cont.) 15

Follow-up to June On-Site Quarterly Meeting What’s Next?  Modify PIP Summary Form to submit baseline data on October 8, 2010  Continue discussion regarding collaborative interventions  HSAG to evaluate baseline data for potential study indicator reduction 16