Wisconsin Department of Health Services Wisconsin Collaborative Bringing

Wisconsin Department of Health Services Wisconsin Collaborative Bringing

Wisconsin Department of Health Services Wisconsin Collaborative Bringing Quality Improvement to Assisted Living Communities Heather Bruemmer, Executive Director/State Ombudsman, Wisconsin Board on Aging & Long Term Care Kevin Coughlin, Policy Initiative AdvisorExecutive, Wisconsin Department of Health Services (DHS) Wisconsin Department of Health Services Covered Topics Overview of the Wisconsin Coalition for Collaborative Excellence in Assisted Living

(WCCEAL) Critical Role of the State Ombudsman Program Current Projects and Next Steps WCCEAL Potential as a National Model Demonstration of the WCCEAL QI (Quality Improvement) Website 2 Wisconsin Department of Health Services History and Critical Events WCCEAL Fact Sheet https:// www.dhs.wisconsin.gov/publications/p01584a.pdf 3

Wisconsin Department of Health Services Media Attention USA Today investigation series, 2004 Washington Post Series, 2004 CBS News, Assisted Living Erratic Regulations, 2006 New York Times, Assisted Living Care: Uneven and Often Problematic, 2008 Miami Herald, Neglected to Death series, 2011 Frontline, Life and Death in Assisted Living, 2013 4 Wisconsin Department of Health Services Federal Government

Attention Assisted living (AL) workgroup: 2001-2003 Government Accounting Office (GAO) reports 5 Wisconsin Department of Health Services Federal Government Attention (contd) U.S. Senate Special Committee on Aging hearings o Ensuring Quality and Oversight in Assisted Living, 2011 o Roundtable: Assisted Living at the Dawn of America's Age Wave: What Have States

Achieved and How Is the Federal Role Evolving?, 2011 o Continuing Care Retirement Communities (CCRCs): Secure Retirement or Risky Investment?, 2010 o Assisted Living: Examining the Assisted Living 6 Working Group Final Report, 2003 Wisconsin Department of Health Services Collaboration Key First Step 7 Wisconsin Department of Health Services

8 Wisconsin Department of Health Services Critical Role of the State Ombudsman Program A Voice for Residential Long Term Care Consumers: http:// longtermcare.wi.gov/docview.asp?docid=21554&locid= 123 Making the Right Choice: Choosing a Residential Facility http:// longtermcare.wi.gov/docview.asp?docid=19904&locid=9

Wisconsin Department of Health Services Critical Role of the State Ombudsman Program (contd) Involvement of the Ombudsman Program from the very beginning of the collaborative was crucial Voice for the consumers living in assisted living facilities Support from the Department of Health Services and the provider associations was valuable as we became a key partner 10 Wisconsin Department of Health Services

Critical Role of the State Ombudsman Program (contd) State Ombudsman involvement enabled discussion on Resident Rights and Resident Satisfaction in the assisted living facilities in Wisconsin Regional Ombudsmen educated providers about the WCCEAL collaboration throughout the state when doing Ombudsman work at the facilities 11 Wisconsin Department of Health Services Internal Quality

Improvement Essential to maintain quality Structure, process and outcome measures used to evaluate quality 12 Wisconsin Department of Health Services WCCEAL Membership criteria o The assisted living community is a member of a major association in good standing (Wisconsin Assisted Living Association [WALA], LeadingAge, Wisconsin Center for Assisted

Living [WiCAL]). o The community is licensed as an assisted living community. o The community has implemented a provider association and department-approved quality improvement program. Adhere to membership rules. o The provider has made a self-attestation that 13 Wisconsin Department of Health Services WCCEAL Provider association sponsored Department approved Comprehensive quality assurance and quality improvement (QA and QI) Includes nine guiding values (handout)

https:// www.dhs.wisconsin.gov/publications/p01584.pdf 14 Wisconsin Department of Health Services One of the Major Guiding Values Continuous Quality Improvement Quality benchmarks Data collection Performance analysis Continuous efforts

15 Wisconsin Department of Health Services Grant to Build the IT Infrastructure UW Institute for Clinical and Translational Research, $200,000 grant July 2011-June 2013 16 Wisconsin Department of Health Services

What Should We Collect? 17 Wisconsin Department of Health Services QA and QI Facility information Resident information Quality measures: o QI structure and process o Resident satisfaction o QI clinical outcomes 18 Wisconsin Department of Health Services

Firewall WCCEAL individual assisted living communities: * Satisfaction results * Indicators *Other reported information Department of Health Services, Division of Quality Assurance, Division of Long Term Care, advocates, and

public 19 What Information Will the AL Community Be Able to Access? Resident satisfaction: Wisconsin Department of Health Services o Community-specific data including comments o Aggregate data from the relevant association to measure performance o Aggregate WCCEAL data to measure performance

Quality improvement variables: o Community-specific data o Aggregate data from the relevant association to measure performance o Aggregate WCCEAL data to measure performance 20 What Data Do the Associations Have Access To? Resident satisfaction: Wisconsin Department of Health Services

o Data from AL communities within each respective association, including individual resident comments o Aggregate data from each respective association o Aggregate WCCEAL data Quality improvement variables: o Data from AL communities within each respective association o Aggregate data from each respective association 21 Wisconsin Department of Health Services

What Data Does DHS Have Access To? Reports on satisfaction and quality indicators for: o Overall WCCEAL o Overall by association o Overall by peer grouping (i.e., by client group, by size, or by other demographics) Note: DHS does not have access to an individual AL communitys data. Note: Ombudsman Program does not have access to an individual AL communitys data. 22

DHS Expectations When Issues Are Identified with an AL Community AL community will put mechanisms in place Wisconsin Department of Health Services to improve identified quality issues. AL communitys association will provide assistance and support for improvement efforts. Center for Health Systems Research and

Analysis (CHSRA) will help associations identify issues from the reports and possible strategies to improve. The AL communitys association will hold the 23 How the Department Will Use the Report Data Ongoing evaluation of the WCCEAL Wisconsin Department of Health Services association's QA and QI approvals

Deploying resources to improve the AL community and support WCCEAL participants Justifying less oversight of WCCEAL qualifying participants to legislators, advocates, funding agencies, and the public Branding WCCEAL as a marker of quality for possible use in value-based 24 Wisconsin Department of Health Services Innovations in American Government Award Program. WCCEAL received the 2014 designation as a Bright Idea.

25 Wisconsin Department of Health Services 2016 AHFSA Promising Practice Award Association for Health Facility Survey Agencies (AHFSA) o Category Quality Improvement, Regulatory Process o http:// www.ahfsa.org/annual-conference/promising-practi ces 26

Wisconsin Department of Health Services Part of a Larger Community WCCEAL collaborative Access to resources and opportunities 27 Wisconsin Department of Health Services Consumer Demand Consumers are more savvy today. Consumers

demand quality. Consumers seek resources and answers to important questions about long term care. 28 Wisconsin Department of Health Services Advocates Assisted living growth is everywhere in this country, get involved and ask questions about the quality of

life and care in your home states. Utilize consumer voice as a resource and our WCCEAL Program. 29 Wisconsin Department of Health Services Competition Raise the bar on quality. Positioned to compete better in the marketplace. 30

Wisconsin Department of Health Services Regulations Proactive approach to regulatory compliance Sustained regulatory compliance Regulatory relief: o If qualified, then less frequent surveys 31 Wisconsin Department of Health Services

Insurance Companies Decrease risk Increase ability to obtain and retain liability insurance Discounts and reduced premiums 32 CMS Guidelines to the States for Home and Community-Based Greater emphasis on quality (HCBS)

waivers Wisconsin Department of Health Services Sections 1915 (c), (i) and (k) of the Act all require states to demonstrate at the time of approval that they have a quality improvement strategy that includes performance and outcome measures for the Medicaid Home and Community Based Services (HCBS) waivers. 33 CMS Guidelines to the States for HCBS waivers In Wisconsin, 51 percent of Family Care

(contd) service expenditure was for AL (Residential Wisconsin Department of Health Services Care Apartment Complexes (RCAC), Community-Based Residential Facilities (CBRF), and adult family homes (AFH)). Thirty-nine percent of enrollees had some service cost during the year for AL. 34 Wisconsin Department of Health Services National Quality Forum Measuring HCBS Quality http:// www.qualityforum.org/Measuring_HCBS_Quality.aspx

This project developed a conceptual framework and performs an environmental scan to address performance measurement gaps in home and community-based services to enhance the quality of community living. Create a conceptual framework for measurement, including a definition for HCBS. Perform a synthesis of evidence and environmental scan for measures and measure concepts. Identify gaps in HCBS measures based on the framework. Make recommendations for HCBS measure development efforts. 35

Wisconsin Department of Health Services Government Oversight and Support for Quality Program Enforcement QA & QI Nursing Home Federal Regulations

State Regulations Quality Improvement Organization (QIO) Advancing Excellence

Nursing Home Quality Initiative AHRQ Nursing Home Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare Quality Improvement Community (QIES)

Nursing Home Compare 5 Star Minimum Data Set Quality Assurance Performance Improvement (QAPI)

Online Survey , Certification and Reporting (OSCAR) Wisconsin Coalition for Collaborative Excellence in Assisted Living (WCCEAL) Assisted Living

Wisconsin Department of Health Services Wisconsin Partnership Program (WPP) Grant WCCEAL awarded five-year $1,000,000 grant to expand current WCCEAL efforts and to establish a comprehensive and robust quality infrastructure for Wisconsin assisted living centers (ALCs). This project has five specific aims: 1. Expand the reach of WCCEAL by working with our support community partners to implement specific strategies to expand active participation by Wisconsin ALCs. 2. Improve the WCCEAL data infrastructure to enable ALC to make data driven quality

37 improvement decisions. Wisconsin Department of Health Services WPP Grant (contd) 3. Evaluate and assess how to integrate WCCEAL participation into the Division of Long Term Care Family Care Quality Strategy. 4. Establish quality improvement collaboratives and informational resources to support ALCs in targeting and improving their individual quality performance. 5. Assess the impact of WCCEAL participation on changes in quality indicators and in regulatory enforcement outcomes. 38

Wisconsin Department of Health Services WCCEAL Demographics As of 12/31/2015 39 Wisconsin Department of Health Services Current Projects Implement five aims of the WPP grant

Fall prevention grant Music & Memory plus iPad grant Secretary Rhoades Music & Memory grant Early adopter study Continued talks with AMDA (The Society for Post-Acute and Long-Term Care Medicine) 40 Wisconsin Department of Health Services Next Steps: WCCEAL Expand the model: o Add more outcomes o Additional learning modalities Potential expansions to other states

Collaboration with national organizations (Assisted Living Federation of America (ALFA), National Center for Assisted Living (NCAL), LeadingAge, Consumer Voice, National Ombudsman Resource Center, Administration for Community Living) 41 Wisconsin Department of Health Services AL Quality Collaborative Model 42 Wisconsin Department of Health Services AL Quality Collaborative

Model with External Partners Assisted Regulatory Living Communiti es Entities Managed Care Organizations Provider Association s Researcher

s Public Funding Agencies Advocates 43 WCCEAL Demo - Visitor Login Process https://wcceal.chsra.wisc.edu/ Username: wccealvisitor New password is: armadillo123 44 Wisconsin Department of Health Services

Questions and Answers Contact information Heather Bruemmer, Executive Director/State Ombudsman Wisconsin Board on Aging and Long Term Care [email protected] 1-800-815-0015 Kevin Coughlin, Executive Policy Initiative Advisor Department of Health Services [email protected] 608-266-6989 45

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