HIV/AIDS BureauDivision of State HIV/AIDS Programs (DSHAP) Ryan White HIV/AIDS Program Part BTechnical Assistance Webinar Building a Quality Management Program January 15, 2014
To provide leadership and support to States/Territories for developing and ensuring access to quality HIV prevention, health care and support services. DSHAP Mission
Presenter Heather Hauck Director Division of State HIV/AIDS Programs
Announcements FY14 RWHAP Part B Base/ADAP Earmark (X07) Awards Important Deadlines: • The due date for the next X07 ADAP Quarterly Report (AQR) Submission (for the 10/1/13-12/31/13 reporting period) is 1/31/2014. • The AQR is being phased out. 4/30/14 will be the last AQR grantees will be required to submit. • Unobligated Balances (UOB) Estimated Carryover: due January 31, 2014
New SPNS FY 14 FOAs Released: • System-level Workforce Capacity Building for Integrating HIV Primary Care in Community Health Care Settings – Demonstration sites HRSA 14-055 • Deadline: March 10, 2014 • System-level Workforce Capacity Building for Integrating HIV Primary Care in Community Healthcare Settings – Evaluation and Technical Assistance – HRSA 14-058 • Deadline: March 10, 2014 • HRSA/HAB will host a technical assistance (TA) webinar Wednesday, January 29, 2014 from 2:00 – 4:00pm EST (HRSA-14-055) and Thursday, January 30, 2014 from 2:00 – 4:00pm EST (HRSA-14-058) Register http://careacttarget.org/events
Other HAB Sponsored Webinars • August 14, 2013; “Preparing for 2014: Overview of Ryan White HIV/AIDS Part B Program policy updates and guidance” sponsored by HAB • August 29, 2013; “Better Together: State Strategies for Medicaid-Ryan White HIV/AIDS Program Coordination” sponsored by National Academy of State Health Policy through its cooperative agreement with HRSA • November 20, 2013; “The Ryan White Program and Understanding Modified Adjusted Gross Income (MAGI)” sponsored by the HIV/AIDS Bureau in partnership with the CMS. • December 4, 2013; “The Ryan White HIV/AIDS Program in States Not Expanding Medicaid” sponsored by HIV/AIDS Bureau
Additional Topics • Cap on charges & sliding fee scales • Role of case managers in outreach and enrollment in Marketplace • Impact of ACA on Ryan White • Ryan White Services Report • Implementation of insurance continuation programs & ACA • Quality Management Plans • ADAP Data Report (ADR)
How Did We Do? • The division met and exceeded it’s goal • 54% of grantee topics addressed • A total of 19 technical assistance webinars completed. An increase of 130%!
2014 Webinar Evaluation Option 1 Option 2 Kpatterson@hrsa.gov email@example.com
Building a Quality Management Program Building a Quality Management Program HAB Expectations Heather Hauck, MSW, LICSW Director Division of State HIV/ AIDS Programs
Objectives • HAB expectations for a Quality Management Program • Components of a Quality Management Program • Grantee Presentation
Zero New Infections • The Ryan White Program funds comprehensive HIV care systems for low-income individuals and families to reduce new HIV infections, to improve health outcomes for PLWH, and to reduce HIV-related health disparities. • HAB ensures the maximum effectiveness of the Ryan White Program by assessing the HIV care and service needs of PLWH, shaping HIV policy, assessing models of care and services required, providing target training of the health care workforce, providing leadership on national HIV/AIDS quality measures.
Quality • Empower stakeholders to deliver high quality HIV care and treatment across the nation. • Establish and monitor key HIV quality measures/indicators to assure high-quality care that address all stages of the care continuum and adhere to DHHS standards. • Collect, analyze, and utilize data on health outcomes of PLWHA to improve and advance the treatment of care.
Quality • HAB advances evidence-based, cost effective HIV care and treatment through the provision of training and capacity development grants and cooperative agreements. • HAB provides leadership on national HIV/AIDS quality measures, including the development, alignment among HHS OPDIVSand other federal agencies and adoption of these measures by Ryan White clinical providers. • HAB promotes clinical quality improvement by HAB staff and grantees through capacity development, monitoring grant activities and implementing special projects and studies.
Components of a Quality Management Program Susan Robilotto, D.O. Clinical Consultant Division of Metropolitan HIV/AIDS Programs Division of State HIV/AIDS Programs
Ryan White HIV/AIDS Treatment Extension Act All Ryan White grantees are required to establish clinical quality management programs to:
Programmatic Expectations • Funding Opportunity Announcement provides minimum expectations for grantees. • Established and implemented a clinical quality management plan; • Established processes for ensuring that Primary Medical Care services are provided in accordance with the Department of Health and Human Services (DHHS) treatment guidelines and standards of care; and • Incorporated quality-related expectations into Requests for Proposals (RFP) and contracts.
Components of a QM Program • Quality Infrastructure • Quality Management Plan • Performance Measures • Quality Improvement Projects
Infrastructure Quality Infrastructure • Infrastructure enhances systematic implementation of improvement activities.
Quality Infrastructure • Quality Management Committee • Leadership • Stakeholders
Quality Management Committee • Builds the HIV program’s capacity and capability for quality improvement • Involves program leaders and other key staff to cement their personal commitment to quality • In a large organization, links the HIV quality program with the organization’s overall quality program
Leadership • Clearly articulated mission and vision statement • Ongoing measurement of performance • Ongoing assessment by leaders • Active coaching by leaders
Stakeholders • How will staff, providers, consumers and others be involved in the CQM program? • Engage internal and external stakeholders • Communicate information about quality improvement activities • Provide opportunities for learning about quality
Quality Management Plan • A quality management plan is a written document that outlines the grantee-wide HIV quality program, including a clear indication of responsibilities and accountability, performance measurement strategies and goals, and elaboration of processes for ongoing evaluation and assessment of the program. • Updated quality management plans are going to be requested from all Part B grantees in FY14
Quality statement Quality infrastructure Performance measurement Annual quality goals Engagement of stakeholders Evaluation Quality Management Planof a Quality Management Plan
The 10 QM Plan Rules • Do not reinvent the wheel, use established frameworks to get started • ‘Steal Shamelessly, Share Senselessly’ • Size does not matter • 80% planning, 20% writing (old software programming rule) • A few visionary annual goals are better than plenty of useful ones
The 10 QM Plan Rules (cont.) 6.Be inclusive, even if it takes longer to get your final QM plan • If you have not touched your plan in the last 6 months, bring it to the next quality committee meeting • A perfect plan is never written • Plans are only as good as their implementation • Get started
Performance Measures Importance of Performance Measures: • Separating what you think is happening from what is really happening • Establishing a baseline and allowing for periodic monitoring • Determining whether changes lead to improvements • Comparing performance with others • Linking performance data to quality improvement activities
HAB Performance Measures • 2007: Started developing and releasing measures under the guidance of Dr. Cheever • Currently 46 measures spanning clinical care, oral health care, ADAP, case management, and systems • Alignment and streamline measure across federal programs • Core measures received National Quality Forum endorsement in February 2013 • http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html
Quality Improvement Projects Imbalance Balance
Quality Improvement Projects PDSA Cycle
Quality Management Program • QM Program evaluation tool • Developed to help project officers and consultants to better evaluate QM Programs during site visits • Identify if a program is meeting legislative requirements • Identify areas in which a program has established “best practices” • Identify areas where a program needs to improve in order to provide a high quality system of care
Quality Management Program Resources: • National Quality Center (NQC) http://nationalqualitycenter.org/index.cfm • NQC Quality Academy http://nationalqualitycenter.org/index.cfm/5847/8860 • HIV/AIDS Bureau (HAB) Performance Measures http://hab.hrsa.gov/deliverhivaidscare/habperformm easures.html
Georgia Department of Public Health Ryan White Part B Quality Management Program HRSA TA Webinar Building a Quality Management Program January 15, 2014 3:00 – 4:00 PM
Acknowledgments • Rosemary Donnelly, SEATEC Clinical Director • Pamela Phillips, RW Part B QM Coordinator • Michael Coker, RW Part B HIV Nurse Consultant • Rachel Powell, RW Part B QM Data Manager • Marisol Cruz, RW Part B Care Manager • William Lyons, HIV Office Director • Kim Brown, HRSA Project Officer • RW Part B QM Core Team and Subcommittees • National Quality Center • RW Part B-funded health district staff • Representatives/Grantees of other Georgia RW Parts
Part B-Funded Health Districts 1-1 Rome 1-2 Dalton 3-1 Cobb-Douglas 3-3 Clayton 3-4 East Metro 4-0 LaGrange 5-1 Dublin 5-2 Macon 6-0 Augusta 7-0 Columbus 8-1 Valdosta 8-2 Albany 9-1 Brunswick/Savannah 9-2 Waycross 10-0 Athens **3-2 Fulton and 3-5 DeKalb are funded primarily by Part A