Quality Assurance and Quality Improvement in Home and Community-Based Services
WISCONSIN
Target Population
Persons with disabilities served through the State's home and community-based services (HCBS) waivers, including elderly persons and adults with physical or developmental disabilities.
Geographic Focus
Statewide.
Primary Focus
- The primary focus of this grant is to develop more effective and coordinated quality assurance and quality improvement (QA/QI) systems in local HCBS waiver programs that will be supported by the State's quality assurance program.
- The State will enlist a consulting organization to help design (a function of the Centers for Medicare & Medicaid Services [CMS] HCBS Quality Framework [hereafter, the Quality Framework]) an effective quality assurance system with model standards for local HCBS programs, including outcome measures to facilitate discovery, remediation, and systems improvement (additional functions of the Quality Framework).
- The Department of Health and Family Services will also review its own quality assurance systems to improve systems to better support local quality activities. The grant will also incorporate a consumer focus in quality system design and develop consumer experience, functional, and clinical participant outcomes and satisfaction to improve system performance (two focus areas of the Quality Framework).
Goals, Objectives, and Activities
Goal: Improve local HCBS programs' QA/QI systems and increase focus on consumer outcomes.
Objectives/Activities
- Identify the features of, and supports necessary for, a basic local QA/QI program, and develop model standards to encourage local agencies to exceed basic standards.
- Develop an effective program of training and technical assistance in QA/QI for use with local care managers, agency managers, and QA/QI staff.
- Develop mechanisms to ensure local agencies' fulfillment of QA/QI requirements, including operation of local QA/QI programs and remediation of detected problems.
Goal: Identify and adopt key consumer-experience outcomes and measure them comparably across all waiver programs.
Objectives/Activities
- Identify a key set of consumer-experience outcomes.
- Conduct a comparative assessment of several different methods of measuring consumer-experience outcomes, including CMS' Consumer Experience Survey.
- Develop methods to consistently measure the key consumer-experience outcomes across target groups and programs.
- Incorporate consumer-experience outcomes in ongoing QA/QI processes and plan for sustainability.
Goal: Identify and adopt key functional and clinical consumer outcomes and measure them comparably across all waiver programs.
Objectives/Activities
- Develop and implement a rigorous statewide screen-quality program.
- Identify a key set of functional or clinical outcomes.
Goal: Develop and implement tools, training, and technical assistance to incorporate consumer focus and consumer outcomes into HCBS programs' care management.
Objectives/Activities
- Incorporate a consumer-outcome focus in all care management tools.
- Design and adopt more effective care-management training and technical assistance.
Goal: Review and revise the State's HCBS programs' QA/QI systems to enable, support, and empower more effective local HCBS QA/QI systems.
Objectives/Activities
- Review and revise standards and processes used at the State level in QA/QI systems for HCBS programs.
- Identify and develop practices to support effective collaboration between local agencies, the Department's waiver QA/QI program, and the Department's facility regulation efforts.
Key Activities and Products
- Develop model standards for a basic local QA/QI program.
- Identify a key set of consumer experience outcomes.
- Develop methods to consistently measure the key consumer experience outcomes across target groups and programs.
- Identify a key set of functional or clinical outcomes.
- Review and revise standards and processes used at the State level in QA/QI systems for HCBS programs.
Consumer Partners and their Involvement in Implementation Activities
A County/Consumer Working Group for HCBS Quality will have significant consumer representation and provide input into grant activities.
Public and Private Partners and their Involvement in Implementation Activities
Public Partners
- The Department will work closely and cooperatively with counties to build the local capacity to take a more active role in waiver quality.
- The Department's Joint Long Term Care Team and the Secretary's Long Term Care Planning Team will contribute to project management.
- The University of Wisconsin's Center for Health Systems Research and Analysis will perform the comparative assessment of the different consumer experience tools currently in use in Wisconsin, along with CMS' new Participant Experience Survey.
Private Partners
The State will subcontract with a consulting firm with expertise in quality issues.
Advisory Body, Committee, or Task Force
- The Statewide Council for Long Term Care Reform will provide overall project direction and oversight. This standing council, appointed by the Department Secretary, is the leading advisory council for long term care for all disability groups in Wisconsin.
- The County/Consumer Working Group is expected to meet at least quarterly.
Formative/Process Evaluation Activities
- The Department will define the goals and timelines for the project in its request for proposal (RFP) and into contracts and subcontracts. Key deliverables will be defined. Open feedback channels will bring issues to the attention of the Department as they arise.
- The Department, in conjunction with its contractors, will build methods for tracking progress toward goals and maintaining guidelines into any contracts developed as a result of this grant. Contractors will submit detailed work plans and periodic progress reports. Department managers will review deviations from goals, deliverables, and timelines to determine if remediation or changes to the project are needed.
- Grant staff will bring issues with impact on the project design to the County/Consumer Working Group and, if necessary, to the Statewide Council on Long Term Care Reform. If some activity or process is not meeting the goals of the project, the Department will review available information and develop a plan of correction.
- The Department and its partners will determine if some fundamental design of the grant process is flawed and should be changed.
Summative/Outcome Evaluation Activities
The Center for Health Systems Research and Analysis will provide a written summary of the consumer experience assessment tools, which will be a comparative evaluation of their cost, utility, reliability, and validity.
Strategies to Ensure Sustainability
- The State will use effective benchmarking to assure better quality programming. Local waiver agencies will be operating with new and more specific requirements, guidance, and support for their care managers and care manager supervisors, QA/QI efforts, and relationships with local providers and State facilities-regulation staff. State and local staff will have better access to QA/QI data.
- The Department and local agencies will use quantitative feedback for well-defined consumer outcomes. Consumers will have more participation in QA/QI processes and will have more useful information about the services on which they depend.