2003 Real Choice
Grant: Update
Quality Close to Home: Building
Tools for Quality
Assurance/Quality
Improvement in Home &
Community-Based Services
General Purpose of the Real
Choice CMS Grants
Provide funding to states to make significant,
enduring changes to infrastructure supporting
HCBS consumers
Promote, promulgate “best practices”
developed by states .
Hot topics: consumer direction, quality
mgmt/CQI, employment, relocation, family
support, incidence management
MN’s 2003 Real Choice Grant
Grant $ builds needed quality tools:
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VA Data Collection system
Data Mart: mini-warehouse to integrate data from MMIS/EIS,
county visits, investigative agencies, complaint offices, etc.
Creates broader, deeper reports & analysis capacity
Consumer survey: make sure we hear about quality of life
and services from people supported under the programs
Systems-generated communication to case managers,
agencies
Source of information to build provider profiles for
MinnesotaHelp.info
Broad Goals of 2003 Grant .
Will support DHS quality management strategy developed
for HCBS
Support CQI in HCBS
Will help address identified areas for improvement in
quality management
Ensure tools serve broadest purpose in quality assessment,
measurement, and uses of findings
Plan for public dissemination of findings: consumer uses
Plan to ensure support when things need to be fixed
(remediation) “So what”
Identify barriers, challenges to completion of HCBS quality
management objectives
Coordinate consumer input
Meet federal mandate under new QA framework
Minnesota’s HCBS Programs: AC,
CAC, CADI, EW, MR/RC, TBI-NF,
TBI-NB
Share common eligibility criteria
Share common quality assurance requirements
Program areas each commit resources to quality
assessment, improvement
Makes sense to coordinate, target, ensure CQI
loop = quality management strategy
Quality Management Diagram:
Possible Activities
Continuing Care Administration's Quality Management Strategy
Quality Assessment & Improvement Activities:
Access, Capacity, Choice, Rights, Health & Safety, Accountability
Desk Audit: data based measures
Ad hoc and production queries
Field audit: On site visits
County implementation of programs
Provider performance, compliance
Consumer Input
Surveys, data measures
Targeted consumer input
Client Record Review
Random sample
Care plan, assessment
Management Review, Assistance
Training & Tech Assistance
Ongoing, targeted
Feedback loops to
quality improvement
activity
Feedback loops to
quality improvement
activity
Feedback loops to
quality improvement
activity
Feedback loops to
quality improvement
activity
Feedback loops to
quality improvement
activity
Other DHS activity
Other Departments, e.g Health
Grant Widens the Window of
Opportunity
- MinnesotaHelp.info: Provider profiles/report card: What
do we/consumers want to know about quality of service
or care, where/how information is collected, how to
import it to MinnesotaHelp.info
- Shared Master Index project: creates opportunity to
identify people in VA report system.
- Recaptures attention to quality strategy, performance
measures, etc.
Focusing the Grant
Minnesota needs:
 Well-integrated incidence management system
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Complete, consistent information for quality
measurement and improvement
Interface between pertinent information systems
Better ways to link data to continuous quality
improvement opportunities (program and policy
development)
Improving QA/QI Design
Ability to identify individuals in HCBS in non-MMIS data
bases is limited
Efficient QA/QI design given resources
Ensure QA efforts support achievement of state goals
as well as federal compliance: develop QA/QI plan,
tools for Minnesota
Indicators at various levels: program, consumer, county,
provider, population
Consumers & Quality
Info about quality that would support consumer choicemaking: provider profiles, e.g.
Strategy and products to communicate quality findings to
public
Quality of life/care indicators that matter to people
supported under the programs
Requires ongoing consumer input: QDC
Vulnerable Adult Report Data System
Product Details
Evaluates use of SSIS for county VA/AP data
submission
Extracts data from counties with mature
databases
Will improve consistency, completeness of report
data
8 volunteer counties to build, test
HIPPA compliant (paper submission of sensitive
data at present)
VA Report Data Collection Product
Details
Provide comprehensive and consistent VA
Report data that can form the basis of
remediation strategies and targeted
improvement efforts.
Provide a more complete picture of locally
investigated reports (about 40% of all
reports).
Vulnerable Adult Report Data
System Product Details
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Allows individuals to be identified with creation
of Shared Master Index, VA Report identifier
Systems-generated communication with case
managers, agencies
Help us identify trends, target TA
Will be critical for CDCS health/safety
Consumer Input into QA/QI:
Product Details
Ombudsman volunteers help pilot, retest tool, conduct
ongoing surveys
Pilot EW survey tool is done, ready for testing. Added
measures related to social roles, relationships, need
some for consumer directed, caregivers, consumer
outcomes to be collected on all HCBS at
assessment/reassessment in MMIS
Quality Design Commission: consumer input into survey
work, indicators work, plan for dissemination of QA
findings
Data Mart Product Details
Quality Data Mart: A place to store &
analyze quality data
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Integrates existing data bases
Interfaces with EIS and MMIS as well as
Licensing, MDH, Appeals, Ombudsman, e.g.
Could also store non-MMIS data (e.g.
Licensing review information, MH data)
Can be supported within the existing IT
environment
Data Mart Product Details
Will house data from VA Report System, County
Assessment Visits, Consumer Surveys, extracted
data from other relevant sources (MDH, eg)
Can be created with several levels of secured
access: county reports, management/division, ad
hoc
Would be source of HCBS provider profile
information for MinnesotaHelp.info
Successful Project Can Help
Minnesota:
Improve incidence management
Make best use of QA/QI resources
Coordinate quality activity into a quality
management strategy
Respond to Elder Justice Act that will require
nat’l reporting of abuse of elders
Successful Project Can Help
Minnesota:
Offer different QA/QI strategy, tools, measures for
consumer directed service options
Develop data driven CQI, program eval
Develop better public dissemination of quality
information/findings, including provider profile
information
Meet federal compliance with new HCBS QA
framework
Work Plan & Timeline
Business Analysis contract: hired effective June 9th.
Data mart design specs, VA data collection method &
specs (includes review of other states): Dec, 2004
EW Consumer Survey: Pilot version completed,
surveys will start mid-July
Random statewide EW survey: wtr/sp, 2005
VA work group: 8 counties, finalizing forms data &
process requirements
QA/QI data mart built: July, 2005
VA Reporting System on line: Sept 2005
View of QA/QI Data Mart
MMIS/EIS : Data Warehouse
QA/QI Data Mart: Tiered Warehouse
EIS data extracted and stored here in a "mini" warehouse
Data from "off-line" data bases extracted and stored here, including VA report data, and consumer survey data
Queries, reports related to selected quality measures, quality assessment, quality improvement
MDH data
Appeals data
VA Report data
Ombudsman
Licensing data
Survey & waiver audit data
Potential Data Relationships for
Quality Data Mart
Education
Corrections
Quality Data
Institutional/Residential
Social Services
Mart
Employment
Family Support
Health
Health Care
Courts
Housing
Data
Sources
Dept of
Dept of MMIS
MAXIS
Economic Health
/EIS (Health Match)
Security Investig
& Other
VA Data
SSIS
Other... License
Reviews, HwServices
Registry Info,
Ombudsman Data
Federal Assurances in MA-Funded HCBS
http://www.cms.hhs.gov/medicaid/waivers/frameworkmatrix
The Matrix: Handout
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Outlines domains that states must address in
program & quality design
Outlines expected outcomes
Outlines primary functions of state monitoring
and oversight
Emphasizes the need for continuous quality
improvement mechanisms
Focuses on consumer input in the quality
design