missouri vocational rehabilitation quality assurance continuous quality improvement

Missouri Vocational Rehabilitation Quality AssuranceContinuous Quality Improvement

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• Why we do it• Where we were• Where we are• Where we are going

Tim Gravier – Director of Case Management Quality AssuranceJill Cremer – Director of Fiscal Quality Assurance



Missouri Vocational RehabilitationMission…..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


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

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



• 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


• 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


• 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


• 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



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.



Case Management QA Review Reports:• Summary of Cases Report• Comments Report• QA Performance Appraisal Report• QA Summary Report



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


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)


Where we are – Fiscal QAStatewide 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


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


Communicating Information- Case Management QA

Improved communication:• Email• QA Newsletter• Office visits• Training• Share Point- Desk References, Newsletter, Memos• Employee Surveys


Communicating Information


Communicating Information- Fiscal QA

Improved communication:• Statewide Email• Office visits• Training• Share Point- Desk References, Memos


Where we are going

• Electronic Imaging• Greater collaboration between Case Management QA & Fiscal QA• New Aware QA Module


Tim Gravier, Missouri VR, Director of Case Management Quality [email protected]

Jill Cremer, Missouri VR, Director of Fiscal Quality [email protected]

mailto:[email protected]

mailto:[email protected]

missouri vocational rehabilitation quality assurance continuous quality improvement

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