LTSS Consumer Quality Technical Workgroup May 22 2014

LTSS Consumer Quality – Technical Workgroup May 22, 2014 (Updated) Gary Montrose & Jose Torres-Vega and Spark Policy Institute

Agenda • Review of LTSS tools used by state partners (from May 2, 2014 state presentations) • Debrief: Dr. Kaye’s presentation for Colorado relevance, opportunities • Review: Cross walk update, utility for future consumer survey work • Explore: Next steps and Scope of Recommendations

Review & Debrief STATE AGENCY LTSS TOOLS

State Agency Instruments CURRENTLY USED

Office of Behavioral Health: Data & Evaluation Unit • MHSIP/YSS-F/YSS (Mental Health Statistics Improvement Program/Youth Services Survey for Families/Youth Services Survey) – Currently piloted: ECHO+ – Two qualitative questions: • +/- aspects of behavioral health services received – 45+ quantitative questions 1. 2. 3. 4. 5. Access to services & general satisfaction Participation in treatment planning Quality of treatment (cultural sensitivity for youth clients) Perceived outcomes Social connectedness & functioning

HCPF/Div. for Intellectual & Developmental Disabilities (DIDD) • NCI–DD Adult Consumer Survey – Currently implemented: First year for Colorado (40 states implement) – Qualitative face-to-face interview 1. 2. 3. 4. 5. Individual outcomes Health, welfare and rights System performance Staff stability Family outcomes – Quantitative • Demographic and basic medical data

• NCI framework comprised of four types of surveys – NCI-DD face to face – Three mail surveys • Adult Family Survey • Family Guardian Survey • Child Family Survey

HCPF • MFP Quality of Life Survey – Qualitative method only (primarily phone interview) 1. 2. 3. 4. 5. 6. 7. Living Situation Choice & Control Access to Personal Care Respect & Dignity Community Integration & Inclusion Satisfaction Health Status – Case managers collect prior to transition from facilitybased care & 11 and 24 months post-transition – Mathematica evaluator

HCPF • CSS Waiver: client satisfaction survey – Qualitative: only in “additional comments” – Quantitative: • Yes/No questions, Likert Scale for overall satisfaction questions & demographics – Domains 1. 2. 3. 4. 5. Their Case Manager Level of involvement and choice in services & providers Availability of information and resources Knowledge of how to file complaints Quality of care received from caregivers – Online survey sent to SEP agencies that mail paper copy to clients

HCPF • CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys for Adult and Child Medicaid (FFS and Managed Care) and CHP+ – Qualitative: member, self-reported (mail & phone) • • Rating of all Health Care Rating of Personal Doctor Rating of Specialist Seen Most Often Coordination of Care – Conducted by HSAG (EQRO) • Random sample – Annual consumer satisfaction survey

State Agency Instruments FUTURE PLANS

HCPF • TEFT (Testing Experience and Functional Tools in Community-Based Long Term Services and Supports – Planning & Demonstration grant funded • Test with Home & Community-Based Services for the Elderly, Blind & Disabled (HCBS-EBD) • HCBS for Supported Living Services – Random sample for each, large enough for statistical analysis – Truven contractor

TEFT (continued) • Domains 1. Services and Supports from personal assistant and behavioral staff 2. Services and Supports from homemakers 3. Case Management 4. Choice 5. Transportation 6. Personal Safety 7. Community Inclusion and empowerment 8. Employment

HCPF • NCI-AD (National Core Indicators – Aging and Disability) – Qualitative: face-to-face interviews 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Service Satisfaction Living Space Safety/Security/Privacy Community Everyday living Relationships Healthcare Planning for Future Independence/Functional Competence Direct Care Workers Health Care Workers – Quantitative • Demographic & medical

Overview and Debrief DR. KAYE’S PRESENTATION

Why Measure LTSS QOL? • States transitioning to managed care • Quality measures help states’ commitment to providing quality services • Quality measures can focus on meeting people’s needs • Quality measures allow advocates to track outcomes • People’s lives are better if they can stay in the community rather than in the institutions

Types of Measures • Structure: The system • Process: Provision of services by the system • Outcomes: Effect of services on consumer*

LTSS Quality & Outcomes: CLPC Conceptual Framework QOL Domains 1. Paid/unpaid LTSS providers 2. Supportive Environment 3. Services & Supports Received 4. Consumer Outcomes

Potential data sources • Program documents & administrators – scope, organization, accountability, etc. • Administrative records – expenditures, participation, settings, services received, complaints, workforce • Medical or claims records (encounter data) – health & functional status, utilization, prevention • National or state survey data – unmet LTSS need, workforce, caregiver support • Surveys of LTSS recipients – adequacy, appropriateness, consumer outcomes

Available LTSS quality tools LTSS program characteristics LTSS Resources Paid & unpaid providers Supportive environment LTSS received The Consumer LTSS Consumer Outcomes LTSS system responsiveness • Survey instruments, e. g. , – National Core Indicators – Developmental Disabilities – Aging & Physical Disabilities – HCBS Experience Survey – Participant Experience Survey – MFP Quality of Life Survey • Consumer outcome/QOL domains – PEONIES – Kane Quality of Life domains – CQL Personal Outcome Measures – Process & structure measures – Indicators

Selecting quality & outcome measures • Clarify your purpose and keep it in mind • Stakeholder & consumer input is critical • Consider using existing measures, either as is or as a starting point for further development • Selecting or developing measures is generally a trade-off: – – – How relevant are the measures? Can the results be used for comparison? Are findings likely to influence policy? How difficult is it to obtain the needed data? Have the measures been tested for validity/reliability?

Steps for Developing Questions • Creating a new instrument – Qualitative interviews to find out what’s important – Develop questions based on understanding which issues are important to the consumer • Cognitive testing of instrument – Pilot the survey/interview – Ask testers to comment on each response

Steps for Selecting Existing Questions • Use the LTSS Question Library to identify potential questions within domains/subdomains – Selection based on what is NOT currently captured through existing state data collection but is important to understand LTSS quality of life

Review CROSSWALK UPDATE & POTENTIAL FUTURE SURVEY WORK

Kaye’s Framework QOL Domains 1. Paid/unpaid LTSS providers 2. Supportive Environment 3. Services & Supports Received 4. Consumer Outcomes

Kaye’s Domains & Subdomains Related to QOL 1. Paid & Unpaid LTSS Providers a. Caregiver/family support b. Workforce development c. Worker availability and quality 2. Supportive Environment a. Accessibility and accommodations b. Technology c. Resources d. Settings

Kayes’ Domains and Subdomains Related to QOL 3. Services and Supports Received a. b. c. d. Adequacy Appropriateness Coordination Utilization 4. Consumer Outcomes a. b. c. d. Health and Function Well-being Participation Safety

Instruments Cross-walked by Kaye’s Domains/Subdomains State of Colorado Uses Nationally recognized instruments 1. National Core Indicators Adult Consumer (NCI- DD): Colorado implement for first time in 2014 3. NCI Family Adult Intellectual and Developmental Disabilities (NCI-I/DD) 2. NCI Aging and Disability (NCI-AD): Colorado will pilot in 2015 5. CQL Basic Assurances 4. CQL – Personal Outcomes Measures (POMS) 6. Personal Experience Outcomes i. Ntegrated Interview and Evaluation (PEONIES)

Kaye “Supportive Environment/ Resources” & POMS “My Self/Security and Continuity”

POMS Detail

Kaye “Supportive Environment/ Resources” & CQL Basic Assurances”

CQL Detail

Overview of the Crosswalk Results DRAFT REPORT

Structure • Assesses NCI-DD and AD by Kaye domains/subdomains • Provides table in each section with – Advisory Committee input on Kaye subdomains – Potential questions derived from other instruments in the crosswalk • Serves as the technical report and basis for a library of questions by domains

Explore NEXT STEPS AND SCOPE OF RECOMMENDATIONS

Proposed Consensus Recommendations 1. Update the 2007 HCPF Quality Strategy from a Consumer Perspective 2. Consumer-Agency Alignment 3. Pursue R&D opportunities regarding “Add -on” questions to standardized surveys 4. Maintain/grow an LTSS Question/Methods Library 5. Pursue funding opportunities