Leiza Johnson, BSN, RN, CDP

Nursing Home Quality Improvement Specialist

Mountain-Pacific Quality Health

ALASKA STATE HOSPITAL & NURSING HOME ASSOCIATION

CHIEF NURSE EXECUTIVE MEETING

DECEMBER 2018

Serves as the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Alaska

Five offices: Alaska, Hawaii, Montana, Wyoming and Guam

Contracted by the Centers for Medicare & Medicaid Services (CMS) to achieve the triple aim: 1) better care 2) better population health 3) lower costs

We have expert staff who facilitate various quality improvement projects across the state

MOUNTAIN-PACIFIC QUALITY HEALTH

ROLE OF THE QIN-QIO

Drive recognition of quality improvement

Provide technical assistance

Provide tools and resources

Share best practices (learning & action

networks)

Partnering with statewide stakeholders

to align efforts

Enhance quality of health care delivery

STRONGDYNAMIC

DIVERSEEXPERIENCED

THE ALASKA TEAM

Sharon ScudderState Director, Alaska

Leiza JohnsonNursing Home Task Lead

Lori ChikoyakAntimicrobial Stewardship

Miranda BurzinskiQuality Reporting

Preston GrooganQuality Reporting

Kyla NewlandAdverse Drug Events

Coleman CutchinsCare Coodination

Cathy ColwellDiabetes Self-Management

CURRENT INITIATIVES FROM CMS AND MOUNTAIN-PACIFIC STAFF

Quality Reporting(Hospitals & Outpatient –

QPP, MIPS, eCQI)

Improving Coordination of

Care

Improving Antimicrobial Stewardship

Reducing Disparities with

Diabetes

Miranda Burzinski

Coleman Cutchins

Lori Chikoyak

Cathy Colwell

Reducing Adverse Drug Events (ADEs)

Improving Cardiac Health

Improving Adult Immunization

Rates

Improving Long-Term Care

Coleman Cutchins &

Kyla Newland

Kyla Newland

Coleman Cutchins

LeizaJohnson

ALASKA LANDSCAPENURSING HOMES

Establish 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 (ANHT) group. CMS established goals for this work: Enrollment target: 35% of all Alaska nursing homes Antipsychotic use reduction target: Reduction in rate (RIR) from baseline targets established of 3%,

9%, 15% and >15% each year (3% RIR by March 2016, etc.) Note: Alaska has failed this measure the past four quarters.

Composite score of <6 target: Rolling targets of 15%, 25%, 45% and 50% of nursing home

partners achieving target by established dates (2016, 2017, 2018)

LEIZA JOHNSONNURSING HOME PROJECT

Represents quality indicators selected to characterize nursing homes’ performance

Includes 13 QMs summed to get overall composite score

Data pulled from nursing home’s Minimum Data Set (MDS) submission

When setting QI targets, CMS recognized best nursing homes had composite score of <6, so this was established as the goal

DEFINING THECOMPOSITE SCORE

SO HOW ARE WE DOING?

PROJECT GOALS:RECRUITMENT

ANHT Collaborative:Exceeded goal!CMS set rolling

targets for recruitment: 6%... 35% of homes to participate with QIN-QIO

18

CMS set rolling goals for recruited nursing homes to improve overall composite score 2016 – 15% of homes to have

score of < 6 2017 – 25% of homes to have

composite score of < 6 2018 – 45% of homes to have

composite score of < 6 2019 – 50% of homes to have

composite score of < 6

PROJECT GOALS:COMPOSITE SCORE

Note: At beginning of project, there were only 17 licensed nursing homes in Alaska.

ANHT Collaborative:Exceeded goal!

< 6:11 NHs

> 6:7 NHs

CMS set rolling targets for reduction in rate (RIR):

PROJECT GOALS: ANTIPSYCHOTIC REDUCTION

Goal:

2016 2017 2018 2019

3% 9%(10.02)

15%(9.36)

>15%

Alaska: Baseline = 11.02 11.59 11.34

PROJECT GOALS: ANTIPSYCHOTIC REDUCTION

We are NOT meeting contract goal(s) –Root cause analysis to evaluate failure.

-6-4-202468

1012

CMS GOAL ACTUAL

20172018

Stakeholder support –ASHNHA! Long-term care ombudsman, Health Facilities Licensing & Certification (“the State”), Alzheimer’s resource of Alaska, University of Alaska Anchorage, others

Alaska Nursing Homes Together (ANHT) interest/engagement

Collaboration between organizations for common goals/cause

“Small state” mentality – willingness to help

Nursing home community in Alaska – friends and colleagues

REASONS FOR SUCCESS

QUESTIONS?

Leiza Johnson, BSN, RNMountain-Pacific Quality Health

ejohnson@mpqhf.org

THANK YOU FOR YOUR TIME!

Developed 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-C2-18-65