Quality Data for LongTerm Care Needs in New

Quality Data for Long-Term Care Needs in New York State Raina Josberger Deputy Division Director Division of Quality Measurement Office of Quality and Patient Safety November 20, 2017

2 Quality Data Sets for Long-Term Care Needs 1. Uniform Assessment System – New York (UAS-NY) • • Community Health Assessment (CHA) Functional Supplement Mental Health Supplement New York required assessments for community-based individuals 2. Outcome and Assessment Information Set (OASIS) C-2 • A Federal required assessment of those receiving services from a Certified Home Health Care Agency 3. Minimum Data Set (MDS) 3. 0 • A Federal required assessment of residents in Medicare and Medicaid -certified nursing facilities

3 UAS-NY - CHA

4 Uniform Assessment System – New York - CHA • Developed by inter. RAI, a not-for-profit research organization • All Managed Long-Term Care plans (MLTCs) transitioned on or before October 1, 2013 to a Web-based software application • • Assessments are recorded electronically and uploaded to the Health Commerce System, assessment are available to DOH in real-time Available to DOH in real-time • Comprehensive assessment that evaluates member’s health and functional status, strengths, and care needs

5 Uniform Assessment System – New York - CHA Who is being assessed with the UAS-NY CHA? And how often? • MLTC enrollees are assessed at enrollment and then every six months • Sooner if there has been a significant change in condition • Members of the Assisted Living Program (ALP) are assessed every six months • Adult day care attendees, who are not enrolled in a MLTC, must be assessed every six months • Traumatic Brain Injury (TBI) waiver members are assessed annually

6 Uniform Assessment System – New York - CHA What are we doing with this data? For MLTC • Annually, DOH computes over 50 descriptive and quality measures • MTLC Annual Report to the DOH website • https: //www. health. ny. gov/health_care/managed_care/mltc/reports. htm • Aggregate data available on Open Data • Annual Consumer Guides • • Concise overview of plan performance by region displayed in a star format https: //www. health. ny. gov/health_care/managed_care/mltc/consumer_guides/ • Managed Long-Term Care Quality Incentive (MLTC QI) • First year, 2013, Pay for Reporting year • Since 2014, Pay for Performance • In 2017, MLTC QI will be $150 million

7 OASIS-C 2

8 OASIS • Developed through a CMS-funded national research program over a 10 -year period • Collection was implemented in 1999 by CMS • OASIS data are collected as part of the comprehensive assessment

9 OASIS Who is being assessed with the OASIS? And how often? • • • Home health care recipients in Certified Home Health Care Agencies are assessed using the OASIS All payer types Assessments at start of care, every 60 days, around inpatient hospitalizations, and at end of care

10 OASIS What is being done with this data? By CMS • • Individual quality measures reporting An overall quality of patient care star rating Measures and ratings available on CMS Home Health Compare at https: //www. medicare. gov/homehealthcompare Public use datasets available at https: //data. medicare. gov/data/home-health-compare By NYS • • Currently programming and calculating the CMS quality measures • Apply inclusion/exclusion criteria specific to NYS population • Risk adjust measures that are adjusted to NYS’ case-mix, not by CMS Intend to make data available on Health Data NY to provide more information for NYS consumers

11 MDS 3. 0

12 MDS 3. 0 • Developed by CMS • Collection was implemented in 1991 • MDS data are collected as part of the comprehensive assessment

13 MDS 3. 0 Who is being assessed with the MDS 3. 0? And how often? • All nursing home residents in Medicare and/or Medicaid-certified nursing homes • All-payer types • Assessments performed at 5, 14, 30, 60, and 90 days • Quarterly assessments after initial 90 days • Any time a significant change in health status occurs (e. g. hospitalizations)

14 MDS 3. 0 What is being done with this data? By CMS • • • Reporting on individual quality measures and a quality of resident care star rating Measures and ratings available on CMS Nursing Home Compare at https: //www. medicare. gov/nursinghomecompare Public use datasets available at https: //data. medicare. gov/data/nursing-home-compare By NYS • • • Nursing Home Quality Initiative (NHQI) • Components of Quality, Compliance and Efficiency CMS quality measures (calculated by NYS) • Apply inclusion/exclusion criteria specific to NYS population • Risk adjust measures that are adjusted to NYS’ case-mix, not by CMS Results available: • Health Data NY at https: //health. data. ny. gov/Health/Nursing-Home-Quality-Initiative-Beginning 2012/aruj-fgbm • NYSDOH website at https: //www. health. ny. gov/health_care/medicaid/redesign/nursing_home_quality_initiative. htm

15 Known Gaps in Quality Measurement for those receiving Long-Term Care Services

16 Known Gaps in Quality Measurement Nursing Home Residents • Need for Resident, Staff and Family satisfaction data • Resource for families selecting a facility for a loved one • Nursing Home Quality Initiative • Advance Care Planning - NYS has requested this to be added to Section S of the MDS 3. 0 Licensed Home Care Services Agencies (LHCSA) • No standardized dataset • No Quality Measures, such as Potential Avoidable Hospitalization Senior Housing • No standardized dataset • No Quality Measures, such as Potential Avoidable Hospitalization Assisted Living • No standardized dataset • No Quality Measures, such as Potential Avoidable Hospitalization