Quality of Care Measures Development

for Medicaid HCBS:  AHRQ Efforts

D. E.B.  Potter,  MS. 

Session:  Quality Measurem...
Overview

I Agency for Healthcare Research and
Quality (AHRQ)

I Quality measures for Medicaid home
and community-based se...
Al-lRQ’s Mission

improve the quality,  safety, 
efficiency and effectiveness of
health care for all Americans

is

 

AHRQ...
AHRQ Research Focus

I Person-centered,  not disease-specific
I Dual focus -=  Services 4- Delivery Systems

I Value-drive...
How AHRQ Focuses on the
Health Care System

 

I Assesses effectiveness,  comparative
effectiveness,  and efficiency of hea...
4 How AHRQ Focuses on the
'- " Health Care System

 

I Focuses on methods to reduce and
eliminate health disparities in a...
Quality Measurement

I Quality measurement for choice

— Consumers

— Purchasers

— Patients

— Clinicians
I Quality measu...
Complexity of llfiedicaiol
l-lCi3S Programs

 

V Physically & cognitively-impaired elders (frailty, 
dementia)

l A Adult...
Personal care assis-
tance

Home health
Skilled nursing
Homemaker

Home—de| ivered
meals

Behavioral supports
Habilitation...
HCBS Providers Include

Home health agencies

Case management agencies
Transportation contractors

Mental and behavioral h...
DRA Section 6086(b)
Quality Measures

 

I “Quality of Care Measures”

I Directs AHRQ,  in consultation with
stakeholders ...
DPJL‘.  Section i5iIl8i3(b)
(continued)

 

— Use measures to assess HCBS, 
outcomes (including health & welfare)
and over...
Steps to Implement
DRA Section 6086(b)

0 Measure Scan Project

0 Determine what Medicaid HCBS
measures to develop

0 Deve...
HCBS Measure Scan Project

I Purpose:  Conduct state-of-the art
environmental scan and science-based
assessment of measure...
HCBS Measure Scan
Products and Key Dates

I Establish Technical Expert Panel
(TEP) of stakeholders (Dec.  2006)

 

I Meth...
HCBS Scan Products
(oont’d)

 

I Final Report

— Scientific assessment of compendium
measures & gaps

- Evidence used by A...
Next Step
Implement DRA Section 6086(b)

0 Measure Scan Project

9 Determine what Medicaid HCBS
measures to develop (early...
i_  Next Steps to Implement DRA
HCBS Quall_t1 of Care Measures

I Based upon scan report & in consultation wl
stakeholders...
Overview

I Agency for Healthcare Research and
Quality (AHRQ)

I Quality measures for Medicaid home and
community-based se...
National Reports on
Quality and Disparities

I National Healthcare Quality Report

I National Healthcare Disparities Repor...
5”F“~ National l-lealflicare Quality Report

L

“     ' State Snapshot Tool

‘pg g un. *,; -3.. .:--. ...  . _-. 

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_ _p by Consumer Assessment of Healthcare
" ‘ " Providers and Systems (CAHPS®)

 

I Surveys & related tools used to asses...
CAHPS® Surveys (cont’d)

I CAHPS supplemental item sets: 
— Children with Chronic Conditions
— People with Mobility Impair...
2007 C/3.}-l PS® Hos pital
Survey Clltartbook

 

2007 CAHPS : 
Hosp tiil Survey
Charlbook

Nlni '4|lv .  14-,  ~i-mi "lri...
CAHPS® People with Mobility
lmpairrrients (PWMI)

I Assess health care experiences of health
plan members who have lower-l...
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II. -I -~v 9-us . uu--m-. *.aIi: u:uina. v.l. ;pu: 

  

fi...
Al-IRQ Quality Indicators (Qls)

I Measures of health care quality (Q)
I Based on readily available hospital inpatient
adm...
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AHRQ Home Page
http: IIwwiv. AHRQ. gov

D. E.B.  Potter,  MS. 
Senior Survey Statistician
Co-Lead,  AHRQ’s LTC Program of ...
Your muesitions? 

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Quality of Care Measures Development for Medicaid HCBS: AHRQ Efforts

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Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: D.E.B. Potter, M.S.

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Quality of Care Measures Development for Medicaid HCBS: AHRQ Efforts

  1. 1. Quality of Care Measures Development for Medicaid HCBS: AHRQ Efforts D. E.B. Potter, MS. Session: Quality Measurement and Outcomes For Persons with Disabilities NASHP’s Annual State Health Policy Conference Denver. 00 October 15, 2007
  2. 2. Overview I Agency for Healthcare Research and Quality (AHRQ) I Quality measures for Medicaid home and community-based services (HCBS) — Deficit Reduction Act (DRA) of 2005 — HCBS Measure Scan Project — HCBS measures next steps I Other AHRQ quality measure resources
  3. 3. Al-lRQ’s Mission improve the quality, safety, efficiency and effectiveness of health care for all Americans is AHRQ’s priority populations include the disabled
  4. 4. AHRQ Research Focus I Person-centered, not disease-specific I Dual focus -= Services 4- Delivery Systems I Value-driven health care — understanding the balance between quality, outcomes. access, and costs I Effectiveness research focuses on actual daily practice, not ideal situations (“efficacy”)
  5. 5. How AHRQ Focuses on the Health Care System I Assesses effectiveness, comparative effectiveness, and efficiency of health care services I Identifies ways to improve patient safety and quality of health care systems I Advances the appropriate use of health information technology
  6. 6. 4 How AHRQ Focuses on the '- " Health Care System I Focuses on methods to reduce and eliminate health disparities in access I Addresses system issues: role of organizational design, management, workflow, management, and incentives on efficiency and effectiveness I Develops data on the health care system for monitoring and decision- making
  7. 7. Quality Measurement I Quality measurement for choice — Consumers — Purchasers — Patients — Clinicians I Quality measurement for improvement I Quality measurement for public health I Quality measurement for accountability
  8. 8. Complexity of llfiedicaiol l-lCi3S Programs V Physically & cognitively-impaired elders (frailty, dementia) l A Adults/ children w/ intellectual or developmental disabilities V‘ Children wl significant impairments — lack of participation in age-appropriate activities, CSHN 7 Adults w/ severe & persistent mental illness I A Adults w/ acquired brain injuries l ‘ Adults w/ physical disabilities and/ or chronic conditions who are at risk of institutional care (e. g., HIV/ AIDS)
  9. 9. Personal care assis- tance Home health Skilled nursing Homemaker Home—de| ivered meals Behavioral supports Habilitation HCBS Services Can Include Transportation Case management Rehabilitation Supported employment Congregate housing Financial manage- ment services Support brokerage
  10. 10. HCBS Providers Include Home health agencies Case management agencies Transportation contractors Mental and behavioral health specialists Fiscal intermediaries Individual providers hired directly by consumers Residential care providers PACE provider organizations Medicaid managed care organizations
  11. 11. DRA Section 6086(b) Quality Measures I “Quality of Care Measures” I Directs AHRQ, in consultation with stakeholders to: - Develop HCBS State Medicaid I Program performance measures I Client function indicators I Measures of client satisfaction
  12. 12. DPJL‘. Section i5iIl8i3(b) (continued) — Use measures to assess HCBS, outcomes (including health & welfare) and overall system — Make available best practices and comparative analysis of the system in each state l By 2010
  13. 13. Steps to Implement DRA Section 6086(b) 0 Measure Scan Project 0 Determine what Medicaid HCBS measures to develop 0 Develop measures 0 Make available measure best practices 6 Use measures (collect data) to assess HCBS outcomes 0 Comparative analysis of the system in each state
  14. 14. HCBS Measure Scan Project I Purpose: Conduct state-of-the art environmental scan and science-based assessment of measures & instruments that could be used to fulfill DRA mandate I HCBS defined broadly to include the array of services that could be provided by Medicaid as HCBS - 1915 (c), 1915 (b), 1915(b)/ (c), 1915 (i), 1915 (j), 1115, Including home health care, personal care services, case management - Variety of state administering agencies, not just Medicaid
  15. 15. HCBS Measure Scan Products and Key Dates I Establish Technical Expert Panel (TEP) of stakeholders (Dec. 2006) I Methods report on how to identify & obtain measures (TEP, Jan. 2007) - httpd/ www. ahrq. govlresearchlltclhcbs. htm I Compendium of 200+ measures (TEP, June 2007)
  16. 16. HCBS Scan Products (oont’d) I Final Report — Scientific assessment of compendium measures & gaps - Evidence used by AHRQ to determine the measures to develop, adapt and/ or test - Preliminary draft (TEP, Jan. 2008) — Draft distributed for public comment (Jan, /Feb. 2008) — Completed, March 2008
  17. 17. Next Step Implement DRA Section 6086(b) 0 Measure Scan Project 9 Determine what Medicaid HCBS measures to develop (early 2008) 0 Develop measures 0 Make available measure best practices 6 Use measures (collect data) to assess HCBS outcomes 0 Comparative analysis of the system in each state
  18. 18. i_ Next Steps to Implement DRA HCBS Quall_t1 of Care Measures I Based upon scan report & in consultation wl stakeholders, AHRQ decides what Medicaid HCBS measures to develop. adapt and/ or test I Measures could be developed via cooperative agreernent(s), oontractor(s) and/ or AHRQ intramural research staff - Will release RFC for HCBS measures support. other mechanisms still possible I Start measures development (2008) I AHRQ will continue to keep all informed. check web: - Project progress: http: IIwww. ahrq. govIresearr: hIltclhcbs. htm — Funding opportunities: http: //www. ahrq. govIfund/
  19. 19. Overview I Agency for Healthcare Research and Quality (AHRQ) I Quality measures for Medicaid home and community-based services (HCBS) - Deficit Reduction Act (DRA) of 2005 - HCBS Measure Scan Project — HCBS measures next steps I Other AHRQ quality measure resources
  20. 20. National Reports on Quality and Disparities I National Healthcare Quality Report I National Healthcare Disparities Report: - 2007 report -- to include measures sfpecific to the disabled population (Jan. 200 ) — 2003/05/06 reports - measures on special care needs children (AHRQ’s MEPS) - 2004 report -- measures from the 2001 Nationa Survey of Children with Special Health Care Needs (U. S. HHS CDC, HRSA & ASPE)
  21. 21. 5”F“~ National l-lealflicare Quality Report L “ ' State Snapshot Tool ‘pg g un. *,; -3.. .:--. ... . _-. -~- ‘-L- v~i«- xi. .. '. l.. ..‘. AJp‘. lI. c-Iuy. ~ '. |.. ..'. AAs1II. l: . . . . 1 mini‘ 3. si-«uni-an-u ‘*‘-~' ' "'-W“-' '-' (V6! . .§i¢. - t. »--i 44» ; .v: .. . .. onlrr . .. s; .». ~l: .4 -24. ‘an: .-A241 -:4‘. .. |: |nAl V: -.~ . it . !v: - . ..-n. r‘. 4:‘
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  24. 24. _ _p by Consumer Assessment of Healthcare " ‘ " Providers and Systems (CAHPS®) I Surveys & related tools used to assess consumers‘ experiences with health care I CAHPS surveys for various settings: - Health Plan Survey (commercial insurance, Medicaid & Medicare plans) (children & adults) — Managed behavioral healthcare organizations - Dental plans — Medical groups, physician offices, & clinics — American Indian Survey - Home Health Care (in development)
  25. 25. CAHPS® Surveys (cont’d) I CAHPS supplemental item sets: — Children with Chronic Conditions — People with Mobility Impairments (PWMI) — Health Literacy (in development) I CAHPS facility surveys: - Hospital Survey — In-Center Hemodialysis Survey — Nursing Home Surveys I National Benchmarking Database
  26. 26. 2007 C/3.}-l PS® Hos pital Survey Clltartbook 2007 CAHPS : Hosp tiil Survey Charlbook Nlni '4|lv . 14-, ~i-mi "lri'll Expr-rnrr: 'n‘vi -': p': Car:
  27. 27. CAHPS® People with Mobility lmpairrrients (PWMI) I Assess health care experiences of health plan members who have lower-limb mobility impairments I PWMI Set consists of 21 questions - Use of mobility equipment (Screener) — Ability to walk and/ or difficulty in walking a quarter mile (Screener-2 items) — Getting physical and occupational therapy - Getting speech therapy — Getting or replacing mobility equipment — Getting mobility equipment repaired
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  29. 29. Al-IRQ Quality Indicators (Qls) I Measures of health care quality (Q) I Based on readily available hospital inpatient administrative data 1. Prevention Qls a potentially avoidable hospital admissions 2. Inpatient Qls - inpatient Q, medical conditions & surgical procedures 3. Patient Safety Indicators - inpatient 0, potentially avoidable complications 5. Pediatric Qls - inpatient Q & admission
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  32. 32. AHRQ Home Page http: IIwwiv. AHRQ. gov D. E.B. Potter, MS. Senior Survey Statistician Co-Lead, AHRQ’s LTC Program of Research Proj. Officer, HCBS Measure Scan Project D. E.B. Potter@ahrq. hhs. gov
  33. 33. Your muesitions? >% . -1 I
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