1. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement

2. Why we do it Why we do it Where we were Where we were Where we are Where we are Where we are going Where we are going Tim Gravier – Director of Case Management Quality Assurance Jill Cremer – Director of Fiscal Quality Assurance Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement

3. Missouri Vocational Rehabilitation Mission …..to provide opportunities and resources to eligible individuals with disabilities leading to successful employment. Vision ….to provide everyone with a great VR experience. Operating Principles Act with a sense of urgency Provide quality customer service Maximize our resources Do the right thing Put people first Continuously evaluate our practices and processes

4. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement Missouri Program Structure: Central Office – Jefferson City, MO 5 Regions 25 District Offices 139 Counseling Staff 64 Administrative Field Staff-Decentralized Billing Aware Case Management System Tableau Reporting Software

5. Why we do it Ensure compliance with state and federal regulations Provide staff support through feedback, training and resource materials Continuously evaluate practices and processes to promote quality customer service and program integrity Staff Engagement Maximize our resources through fiscal and case management data collection and analysis Collaboration with all aspects of our agency Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement

6. 12 to 15 staff reviewers 10 files per counselor – every other year One-on-One feedback for each case review District Supervisor would receive a report of areas needing improvement Was like an inquisition Focused on the negative Minimal case review (not representing true performance or trends) Where we were – Case Management QA

7. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement Accounting staff responsible for fiscal reviews of district offices All review team members were fiscal/accounting staff 2-year rotation Review sample size = Approximately 150 cases Review sample consisted of all types of expenditures Reported review findings to supervisory & billing staff Inconsistent information Unrealistic Expectation of Change Minimal follow-up Staff perceived reviews as punitive Reactive Approach Where we were – Fiscal QA

8. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement QA staff member becomes the project manager from a rotating list Cases are pulled electronically at random QA team discusses review findings Feedback provided to office/staff QA Tool Originally 186 questions; mostly compliance driven Currently 92 questions Quality Questions recur section to section Some directly related to Counselor Performance Appraisals Where we are – Case Management QA

9. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement Peer Reviews: To engage staff in the QA process Promote leadership activities Open discussion among peer review participants Learn from work reviewed across the state Provide feedback to QA on improving the process Share experiences back in their offices Review more cases in a smaller time frame Collaborating Fiscal QA and Case Management QA Improved communication and visibility Where we are – Case Management QA

10. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement FY14 (October 1, 2013 to September 30, 2014) QA Case Management conducted 3619 case reviews including: 19 Probationary (11 months) Reviews = 680 cases. 21 Promotional (23 months) Reviews = 840 cases. 3 Special Reviews = 140 cases. 7 Statewide Status (single sections of the QA tool) Reviews = 1674 cases. 2 Peer Reviews = 285. 04/2014 – 108 cases reviewed: 57 Closed-Rehabilitated; 51 Closed-Other. 07/2014 – 177 cases reviewed: 76 Closed-Rehabilitated; 101 Closed- Other. Where we are – Case Management QA

11. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement Case Management QA Review Reports: Summary of Cases Report Comments Report QA Performance Appraisal Report QA Summary Report Where we are – Case Management QA

12. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement Where we are – Fiscal QA Fiscal QA unit established in 2011 2013 – New Fiscal QA Process Focus on Staff Support vs. Auditing Review Team= Representation from Fiscal QA, Case Management QA, Accounting Staff & Client Services Staff (District Supervisors & Regional Managers) Statewide-sample from all district offices Review Sample Size=150 payment lines of recent expenditures Review Sample consists of a particular payment category Proactive Approach

13. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement Where we are – Fiscal QA Completed since implementation of new process: 10 Fiscal QA Reviews (CRP Services, M&T, P-Card, Verification of Service, Refunds, College) 3 Fiscal QA Reviews using Data Mining (Authorization Compliance, payment timeliness, fiscal process implementation)

14. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement Where we are – Fiscal QA Statewide Fiscal QA Reviews: Promotes staff engagement in the QA process Encourages open discussion among review team Fosters collaboration between Fiscal QA and Case Management QA Improves communication and visibility Manageable expectation of change Consistent guidance/feedback Timely follow-up & reevaluation if necessary

15. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement Where we are – Fiscal QA Fiscal QA Review Reports: QA Tool Questions & Supplemental Information Summary of Review Report Statewide Comment Report District Office Comment Report with required follow-up

16. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement Communicating Information- Case Management QA Improved communication: Email QA Newsletter Office visits Training Share Point- Desk References, Newsletter, Memos Employee Surveys

17. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement Communicating Information

18. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement Communicating Information- Fiscal QA Improved communication: Statewide Email Office visits Training Share Point- Desk References, Memos

19. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement Where we are going Electronic Imaging Greater collaboration between Case Management QA & Fiscal QA New Aware QA Module

20. Missouri Vocational Rehabilitation Quality Assurance Continuous Quality Improvement Tim Gravier, Missouri VR, Director of Case Management Quality Assurance tim.gravier@vr.dese.mo.gov Jill Cremer, Missouri VR, Director of Fiscal Quality Assurance jill.cremer@vr.dese.mo.gov