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MIHP NEW PROVIDER ORIENTATION. Day 5. Maternal Infant Health Program Quality. “Successful implementation of a Quality Improvement program begins with an honest and objective assessment of an organization's current culture, and its commitment to improving the quality of its care and services.”
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“Successful implementation of a Quality Improvement program begins with an honest and objective assessment of an organization's current culture, and its commitment to improving the quality of its care and services.” Retrieved on 4/3/18 from http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/
Quality Assurance vs Quality Improvement Quality Assurance • Quality assurance (QA) measures compliance against certain necessary standards, typically focusing on individuals and tends to be defensive with a focus on providers. Quality Improvement • Quality improvement (QI) is a continuous improvement process focused on processes and systems, and is proactive and preventive in nature, focusing on patient care. www.hrsa.aquilentprojects.com/healthit/toolbox/HealthITAdoptiontoolbox/QualityImprovement/whata rediffbtwqinqa.html
Standards and measures developed for quality assurance can inform the quality improvement process http://www.hrsa.aquilentprojects.com/healthit/toolbox/HealthITAdoptiontoolbox/QualityImprovement/whata rediffbtwqinqa.html
Quality Requirements – Indicator 48 • The name of the care coordinator must be documented in the beneficiary’s record. (Section 2.6, Care Coordinator, MIHP, Medicaid Provider Manual) • A specific registered nurse or licensed social worker will be identified as the care coordinator assigned to monitor and coordinate all MIHP care, referrals, and follow-up services for the beneficiary. (Section 2.6, Care Coordinator, MIHP, Medicaid Provider Manual) • The care coordinator is responsible for monitoring and coordinating all care provided for the beneficiary. This means the care coordinator follows up with the other professionals who are working with the beneficiary.
Indicator 48Pre-review Protocol Pre-review Protocol • The case manager’s process for conducting quarterly chart reviews to determine: • If beneficiary has been seen every month. • The extent to which the POC is being implemented and whether it needs modification. • If appropriate referrals have been made and followed up on. • If service delivery is meeting the beneficiary’s needs.
Quality Requirements – Indicator 49 MIHP coordinators are expected to routinely conduct their own internal quality assurance activities, including chart reviews and billing audits. (Section 5, 1-1-19 MIHP Operations Guide)
Indicator #49 Protocol • Protocol Describes: • Internal quality assurance activities • Chart reviews and billing audits are conducted quarterly, or more frequently • The staff position(s) that performs chart reviews and billing audits • The minimum number of charts reviewed per chart review and per billing audit • How staff are trained and supported to ensure that the Risk Identifier, POC, Professional Visit /Progress Notes, and Discharge Summaries are connected • How staff works with the beneficiary to identify needs at program entry and periodically asks beneficiary if services being provided are meeting beneficiary needs
Indicator #49 Staff Interview Staff Interview indicates that staff can: • Generally describe the protocol • Explain how the Risk Identifier, POC, Professional Visit Progress Notes, and Discharge Summaries are connected
Indicator #49 Onsite Document Review Review of Documentation • Completed forms or tools for program chart audit • Completed forms or tools for billing chart audit • Indicates that reviews and audits are being conducted through review of completed tools and evidence throughout rating of certification indicators • Program and billing chart reviews conducted at least quarterly • Staff participating in chart reviews.
How to Access Quarterly Report Data MIHP quarterly data reports are available through agency CHAMPS inbox Data Period Distribution Period Q1 (Oct – Dec) 1st week in July Q2 (Jan – Mar) 1st week in October Q3 (Apr – June) 1st week in January Q4 (Jul – Sept) 1st week in April Distribution Method Distributed to CHAMPS agency inboxes
17 MIHP Quarterly Report Data Quarterly reports include: • Screens Completed • Discharges Completed • Demographics • Risk Screening Domain Scores • Referrals • Breastfeeding Information
18 MIHP Quarterly Report Demographic Data Provider specific demographic measures • Marital Status • Race/Ethnicity • Educational Level • Screener Discipline • Breastfeeding Status • Age at time of screening • Services by Risk Demographics
Using MIHP Quarterly Reports Why do I have all of this data? and . . . What do I do with it? Demographics
Plan - Do - Check - Act Modified from Deming’s PDSA • Plan – Recognize and analyze the problem needing improvement • Do – Develop and Test the solution • Check – Review the test and study the results • Act – Take action based on what you learned in the study step: Adopt, adapt, or abandon PDCA - Wikipedia, the free encyclopedia Accessed at https://en.wikipedia.org/wiki/PDCA
PDCA Plan Recognize and analyze the problem needing improvement • The problem, 13% of the agency’s Risk Identifiers are incomplete. • Largest percent (12.3%) due to no total score.
PDCA Why is this a problem? • No risk score means no POC for the beneficiary • Agency is “holding” the risk identifier in the database preventing another agency from seeing mom • Limits services to a high risk population • Agency can’t bill until RI is complete
PDCA • Analyze data further looking for incomplete risk identifiers by individual staff • Look for trends • Form the plan to improve the problem
PDCA Check and Assess the intervention results This Photo by Unknown Author is licensed under CC BY-SA
PDCA Check – Review the intervention results • Assess the number of Incomplete risk identifiers • Number increased, decreased, stagnant • How close to your goal?
PDCA • Act – Take action based on the assessment of the plan • Adopt, adapt, or abandon
PDCA Act – Take action based on the assessment of the plan and then: Adopt The plan worked Adapt The plan worked but fell short of the goal • Reassess • Adjust plan Abandon The plan did not work • Need a new plan • Back to the drawing board
Take Away Points Don’t assume you know what the problem is - - Do the PLANNING Check data and every available resource to discover the true problem Ask staff to help assess the problem Survey clients when appropriate DO Interventions - - brainstorm with staff to plan the intervention that will work best in your agency Pick a goal and timeline to CHECK the results of the interventions Decide what your ACTion will be and your next steps . . . Adopt, Adapt, or Abandon
REMEMBER The ultimate goal of quality improvement is to deliver MIHP services that improve outcomes for Michigan families
MIHP Chart Review Why, When, Who, and how
