NHDP Quarterly MeetingPerformance Improvement Projects

September 30th, 2010

Presenters:

Don Grostic, MSAssociate Director, Research and Analysis

Yolanda Strozier, MBAProject Manager, State and Corporate Services

Performance Improvement Projects

-IMPROVEMENT-

Plans now familiar with validation requirements

Emphasis on improving outcomes

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Four Reasons PIP Outcomes Don’t Improve

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Rates are already at a very high level

Example: The baseline rate exceeds the goal and/or

benchmark

Suggestion: Analyze historical data before identifying

PIP topics or study indicators Make certain the performance can be

improved5

Barriers are not specific

Example: Barrier – Lack of knowledge (members

and/or providers)

Suggestion: Identify the specific knowledge gap Member lacks knowledge regarding the

purpose of an advanced directive

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Interventions are not specific to the PIP study timeline

Example: Interventions have been ongoing for

multiple years and rates remain suboptimal

Suggestion: Ensure that new strategies are implemented

during the study Interventions prior to Baseline are

potentially ineffective7

Intervention’s success cannot be evaluated

Example: The plan documented 20 different

interventions

Suggestion: Develop targeted interventions Reduce the overall number of interventions Ensure interventions are synergistic Incorporate evaluation of the interventions

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Data Drives the

Improvement Process

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Key Improvement Concepts Know the rates for applicable demographic

subgroups Prioritize barriers; all barriers do not have

to be addressed Strategize interventions and intervention

types based on barrier analysis Identify an evaluation plan for each

intervention prior to implementation Submit supporting documentation for the

entire improvement process 10

NHDP Preliminary Baseline Results for Timeliness of Services, SFY 2008–2009*

Study IndicatorPlan A Pan B

Baseline Baseline N Rate N Rate

1) The percentage of eligible NHDP members who received home health services, adult day health, or home-delivered meals:

a) Within 3 calendar days from the effective date of enrollment. 372 29.0% 152 50.0%b) Within 5 calendar days from the effective date of enrollment. 372 43.8% 152 61.2%c) Within 7 calendar days from the effective date of enrollment. 372 56.5% 152 67.1%d) Within 10 calendar days from the effective date of enrollment. 372 68.8% 152 74.3%

2) The percentage of eligible NHDP members who received home health services:a) Within 3 calendar days from the effective date of enrollment. 323 27.9% 141 30.5%b) Within 5 calendar days from the effective date of enrollment. 323 40.2% 141 44.7%c) Within 7 calendar days from the effective date of enrollment. 323 52.3% 141 53.9%d) Within 10 calendar days from the effective date of enrollment. 323 61.6% 141 63.1%

3) The percentage of eligible NHDP members who received adult day health: a) Within 3 calendar days from the effective date of enrollment. 44 25.0% 14 71.4%b) Within 5 calendar days from the effective date of enrollment. 44 29.5% 14 71.4%c) Within 7 calendar days from the effective date of enrollment. 44 38.6% 14 71.4%d) Within 10 calendar days from the effective date of enrollment. 44 45.5% 14 78.6%

4) The percentage of eligible NHDP members who received home-delivered meals: a) Within 3 calendar days from the effective date of enrollment. 215 7.4% 80 48.8%b) Within 5 calendar days from the effective date of enrollment. 215 17.2% 80 50.0%c) Within 7 calendar days from the effective date of enrollment. 215 24.2% 80 53.8%d) Within 10 calendar days from the effective date of enrollment. 215 38.1% 80 56.3%

* Baseline results were not required of the NHDPs for the current validation year; preliminary results were not validated.

Collaborative Baseline Results Submitted FY 2009-2010

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I. Activity IX: Report improvement. Enter results for each study indicator, including benchmarks and statistical testing with complete p values, and statistical significance.

Time PeriodMeasurement

CoversBaseline Project Indicator

Measurement Numerator DenominatorRate or Results

Industry Benchmark

Statistical Test Significance and p value

Quantifiable Measure 1:

Baseline - 1a

Baseline - 1b

Baseline - 1c

Baseline - 1dQuantifiable Measure 2:

Baseline - 2a

Baseline - 2b

Baseline - 2c

Baseline - 2d

Note - Repeat for each study indicator

Collaborative Baseline Results Submission October 8, 2010

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Intervention Strategies Worksheet

Member InterventionsWhat Makes Them

EffectiveBarriers

Telephone outreach within 2 business days

Identify immediate needs and confirm demographics

Timely referral Incorrect demographics

Conduct orientation visit 5 or more days prior to the effective date of enrollment

Time to conduct effective assessment to generate care plan to provide services timely

Family unavailable Member unavailable Untimely referrals from

CARESCM telephone outreach to verify services are in place

Verification of service Available staff due to enrollment management

Educate member/care giver to call to verify authorization services are in place for start date

Verification of services Safety net

Diminished capacity

Implement care plan Able to tell that the member is receiving services

Member unavailable Untimely referrals from

CARES

Timeliness of Services Collaborative PIP June 2010 Quarterly Meeting

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Intervention Strategies Worksheet

Provider InterventionsWhat Makes Them

EffectiveBarriers

Reviewing contracts and ongoing education with providers and setting expectations.

Provider knows expectations

Staff time to find point person

Storing frozen foods in local area.

Accessible to providers Timely delivery to enrollees

Find appropriate environment for storing food

Modify authorization form to meet or highlight expectations.

Collaborative group modifies form

Makes expectations clear

Education

Audit documentation (logs). Joint meeting with providers.

Keeps the providers in check

Members will need to share information/complaints

Staff time (training, primary source verification)

Follow-up calls with providers after sending faxes (develop fax back form).

Confirm fax is clear and that the right person received the fax

Time to make the calls

Timeliness of Services Collaborative PIP June 2010 Quarterly Meeting (cont.)

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Intervention Strategies Worksheet

System InterventionsWhat Makes Them

EffectiveBarriers

Authorizations are sent to provider prior to start date.

Written confirmation with receipt

Was it staffed timely and appropriately?

Billing procedures utilized. In real time Claims aren’t as timely

Implement electronic medical record enabling.

Legible Timely

Eliminating handwritten data entry error

ASO, care plan, and claims payment system.

Quicker adjudication More centralized Integrate system

Claims lag behind integration

E-fax service authorizations. Not manual No real time proof service was delivered at that time

Timeliness of Services Collaborative PIP June 2010 Quarterly Meeting (cont.)

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Follow-up to June On-SiteQuarterly Meeting

What’s Next? Modify PIP Summary Form to submit

baseline data on October 8, 2010 Continue discussion regarding collaborative

interventions HSAG to evaluate baseline data for

potential study indicator reduction

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