1. Presentation by:
Leiza Johnson, BSN, RN, CDP
Nursing Home Quality Improvement Specialist
Mountain-Pacific Quality Health
Alaska state hospital & nursing home association chief nurse executive meeting April

2. Mountain-pacific quality health
Serves as the Medicare Quality Innovation Network- Quality Improvement Organization (QIN-QIO) for Alaska
Five offices that serve Alaska, Hawaii, Montana, Wyoming and U.S. Pacific Territories of Guam, American Samoa and the Commonwealth of the Northern Mariana Islands
We have expert staff who facilitate various quality improvement projects across the state

3. Contracted by CMS Better Health Better Care Lower Costs
Centers for Medicare & Medicaid Services (CMS) Three Aims for Health Care
Better Health
Better Care
Lower Costs

4. Role of the QIN-QIO Drive recognition of quality improvement
Enhance quality of health care delivery
Provide technical assistance
Partner with statewide stakeholders to align efforts
Provide tools and resources
Share best practices (learning & action networks)

5. Our Alaska Team Is…
STRONG
DIVERSE
DYNAMIC
EXPERIENCED

6. The Alaska team Sharon Scudder State Director, Alaska Preston Groogan
Quality Reporting
Leiza Johnson
Nursing Home Task Lead
Kyla Newland
Adverse Drug Events
Lori Chikoyak
Antimicrobial Stewardship
Coleman Cutchins
Care Coordination
QIN-QIO is Quality Innovation Network – Quality Improvement Organization
CMS created QIOs essentially to help make sure their money is spent wisely.
Role of QIN-QIO:
CMS contracts with QINs across the US. Various contracts all with ‘triple aim’ of improving patient experience, reducing cost, decreasing HACs/improving clinical outcomes
MPQH has task leads (in Alaska!) working on:
Antimicrobial stewardship/CDI – across settings
Diabetes self management
Reducing readmissions
Safe medication practices (ADEs, cardiac, diabetic)
Role in reducing HACs – part of the contract is related to nursing home QI. Goals set by CMS are:
50% of collaborative will achieve composite of <6
Antipsychotic RIR
Etc.
ANHT collaborative – 100% commitment by all AK nursing homes. Etc etc
Partners to support ANHTs: licensing & certification, ASHNHA, Alz Resource of AK, GWEP, ANTHC, Mental Health Trust, etc.
Oh and I like to say we have a big state, little mascot… 
* Leiza – began in QA in 1990’s – worked in Nome – came to Anch began to ‘specialize in JCAHO’ – went to school to get RN – worked in adolescent psych – full circle back to quality
Miranda Burzinski
Quality Reporting
Cathy Colwell
Diabetes Self-Management

7. Current Initiatives from CMS and Mountain-Pacific Staff
Quality Reporting
(Hospitals & Outpatient –
QPP, MIPS, eCQI)
Miranda Burzinski
Improving Coordination of Care
Coleman Cutchins
Improving Antimicrobial Stewardship
Lori
Chikoyak
Reducing Disparities with Diabetes
Cathy
Colwell
Reducing Adverse Drug Events (ADEs)
Coleman Cutchins &
Kyla Newland
Improving Cardiac Health
Kyla
Newland
Improving Adult Immunization Rates
Improving Long-Term Care
Leiza
Johnson

8. Leiza Johnson nursing home project
Establish a collaborative of nursing homes to work with the QIN-QIO on quality improvement initiatives
In Alaska, this collaborative is called the Alaska Nursing Homes Together or “ANHT” group
CMS established three main goals for this work:
Enroll 35% of all Alaska nursing homes to participate in the work
**Reach a composite score target of <6
Rolling goal of 15%, 25%, 45% and 50% of nursing home partners achieving the target by established dates (2016, 2017 and 2018)
Reduce antipsychotic use
Reduction in rate (RIR) from baseline targets established of 3%, 9%, 15% and >15% each year (3% RIR by March 2016)
Note: Alaska has failed this measure the past two quarters
**more on the Composite Score later

9. Project goals
Exceeded Goal!
Exceeded Goal!

10. Project goals – antipsychotic reduction
We are NOT meeting contract goal(s) – Root Cause Analysis to evaluate failure.

11. Issues with antipsychotic measures
Small sample size – half of the ANHTs are less than 20 beds
Small numbers ‘skew’ the data making it more difficult to identify those nursing homes with legitimate quality issues
The CMS Quality Measure does not take into account the Gradual Dose Reduction (GDR) process
Many antipsychotics started in acute care or the community prior to the nursing home admission

12. Issues with antipsychotic measures
GDR process takes time – until all antipsychotics are discontinued a resident will continue to trigger this QM
Alaska began the contract with the second lowest antipsychotic rate in the nation, leaving less “low-hanging fruit” and highlighting the good practice(s) we have in our state

13. composite score measure
Represents quality indicators selected to characterize nursing homes’ performance
Includes 13 quality measures (QMs), which are summed to get an overall composite score
Data is pulled from the nursing home Minimum Data Set (MDS) submission
When setting quality improvement (QI) targets, CMS recognized the best nursing homes had a composite score of <6, so this was established as the goal

14. Sample composite report state of Alaska

15. State of Alaska QMs

16. Questions? Leiza Johnson, CDP, BSN, RN Mountain-Pacific Quality Health ejohnson@mpqhf.org

17. Thank you for your time!
Ddeveloped by Mountain-Pacific Quality Health, the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Montana, Wyoming, Alaska, Hawaii and the U.S. Pacific Territories of Guam and American Samoa and the Commonwealth of the Northern Mariana Islands, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-MPQHF-AK-C