Wisconsin Department of Health Services Wisconsin Collaborative Bringing

Wisconsin Department of Health Services Wisconsin Collaborative – Bringing Quality Improvement to Assisted Living Communities Heather Bruemmer, Executive Director/State Ombudsman, Wisconsin Board on Aging & Long Term Care Kevin Coughlin, Policy Initiative Advisor-Executive, Wisconsin Department of Health Services (DHS)

Wisconsin Department of Health Services Covered Topics • Overview of the Wisconsin Coalition for Collaborative Excellence in Assisted Living (WCCEAL) • Critical Role of the State Ombudsman Program • Current Projects and Next Steps • WCCEAL Potential as a National Model • Demonstration of the WCCEAL QI (Quality Improvement) Website 2

Wisconsin Department of Health Services History and Critical Events WCCEAL Fact Sheet https: //www. dhs. wisconsin. gov/publications/p 01584 a. pdf 3

Wisconsin Department of Health Services Media Attention • USA Today investigation series, 2004 • Washington Post Series, 2004 • CBS News, “Assisted Living Erratic Regulations, ” 2006 • New York Times, “Assisted Living Care: ‘Uneven and Often Problematic, ’” 2008 • Miami Herald, “Neglected to Death” series, 2011 • Frontline, “Life and Death in Assisted Living, ” 2013 4

Wisconsin Department of Health Services Federal Government Attention • Assisted living (AL) workgroup: 2001 -2003 • Government Accounting Office (GAO) reports 5

Wisconsin Department of Health Services Federal Government Attention (cont’d) U. S. Senate Special Committee on Aging - hearings o Ensuring Quality and Oversight in Assisted Living, 2011 o Roundtable: Assisted Living at the Dawn of America's “Age Wave”: What Have States Achieved and How Is the Federal Role Evolving? , 2011 o Continuing Care Retirement Communities (CCRCs): Secure Retirement or Risky Investment? , 2010 o Assisted Living: Examining the Assisted Living Working Group Final Report, 2003 6

Wisconsin Department of Health Services Collaboration Key First Step 7

Wisconsin Department of Health Services 8

Wisconsin Department of Health Services Critical Role of the State Ombudsman Program A Voice for Residential Long Term Care Consumers: http: //longtermcare. wi. gov/docview. asp? docid=21554&locid=123 Making the Right Choice: Choosing a Residential Facility http: //longtermcare. wi. gov/docview. asp? docid=19904&locid=123 9

Wisconsin Department of Health Services Critical Role of the State Ombudsman Program (cont’d) • Involvement of the Ombudsman Program from the very beginning of the collaborative was crucial • Voice for the consumers living in assisted living facilities • Support from the Department of Health Services and the provider associations was valuable as we became a key partner for WCCEAL 10

Wisconsin Department of Health Services Critical Role of the State Ombudsman Program (cont’d) • State Ombudsman involvement enabled discussion on Resident Rights and Resident Satisfaction in the assisted living facilities in Wisconsin • Regional Ombudsmen educated providers about the WCCEAL collaboration throughout the state when doing Ombudsman work at the facilities 11

Wisconsin Department of Health Services Internal Quality Improvement • Essential to maintain quality • Structure, process and outcome measures used to evaluate quality 12

Wisconsin Department of Health Services WCCEAL Membership criteria o The assisted living community is a member of a major association in good standing (Wisconsin Assisted Living Association [WALA], Leading. Age, Wisconsin Center for Assisted Living [Wi. CAL]). o The community is licensed as an assisted living community. o The community has implemented a provider association and department-approved quality improvement program. Adhere to membership rules. o The provider has made a self-attestation that they are in substantial compliance with all regulations. 13

Wisconsin Department of Health Services WCCEAL • Provider association sponsored • Department approved • Comprehensive quality assurance and quality improvement (QA and QI) • Includes nine guiding values (handout) https: //www. dhs. wisconsin. gov/publications/p 01584. pdf 14

Wisconsin Department of Health Services One of the Major Guiding Values Continuous Quality Improvement • • Quality benchmarks Data collection Performance analysis Continuous efforts 15

Wisconsin Department of Health Services Grant to Build the IT Infrastructure • UW Institute for Clinical and Translational Research, $200, 000 grant • July 2011 -June 2013 16

Wisconsin Department of Health Services What Should We Collect? 17

Wisconsin Department of Health Services QA and QI • Facility information • Resident information • Quality measures: o QI structure and process o Resident satisfaction o QI clinical outcomes 18

Wisconsin Department of Health Services Firewall WCCEAL individual assisted living communities: * Satisfaction results * Indicators *Other reported information Department of Health Services, Division of Quality Assurance, Division of Long Term Care, advocates, and public 19

Wisconsin Department of Health Services What Information Will the AL Community Be Able to Access? • Resident satisfaction: o Community-specific data including comments o Aggregate data from the relevant association to measure performance o Aggregate WCCEAL data to measure performance • Quality improvement variables: o Community-specific data o Aggregate data from the relevant association to measure performance o Aggregate WCCEAL data to measure performance o Peer group data to measure performance 20

Wisconsin Department of Health Services What Data Do the Associations Have Access To? • Resident satisfaction: o Data from AL communities within each respective association, including individual resident comments o Aggregate data from each respective association o Aggregate WCCEAL data • Quality improvement variables: o Data from AL communities within each respective association o Aggregate data from each respective association o Aggregate WCCEAL data o Data from peer groups 21

Wisconsin Department of Health Services What Data Does DHS Have Access To? • Reports on satisfaction and quality indicators for: o Overall WCCEAL o Overall by association o Overall by peer grouping (i. e. , by client group, by size, or by other demographics) • Note: DHS does not have access to an individual AL community’s data. • Note: Ombudsman Program does not have access to an individual AL community’s data. 22

Wisconsin Department of Health Services DHS Expectations When Issues Are Identified with an AL Community • AL community will put mechanisms in place to improve identified quality issues. • AL community’s association will provide assistance and support for improvement efforts. • Center for Health Systems Research and Analysis (CHSRA) will help associations identify issues from the reports and possible strategies to improve. • The AL community’s association will hold the community responsible for implementing its QA/QI program. 23

Wisconsin Department of Health Services How the Department Will Use the Report Data • Ongoing evaluation of the WCCEAL association's QA and QI approvals • Deploying resources to improve the AL community and support WCCEAL participants • Justifying less oversight of WCCEAL qualifying participants to legislators, advocates, funding agencies, and the public • Branding WCCEAL as a marker of quality for possible use in value-based purchasing, insurance discounts, and other comparable circumstances 24

Wisconsin Department of Health Services • Innovations in American Government Award Program. • WCCEAL received the 2014 designation as a Bright Idea. 25

Wisconsin Department of Health Services 2016 AHFSA Promising Practice Award Association for Health Facility Survey Agencies (AHFSA) o Category – Quality Improvement, Regulatory Process o http: //www. ahfsa. org/annual-conference/promising-practices 26

Wisconsin Department of Health Services Part of a Larger Community • WCCEAL collaborative • Access to resources and opportunities 27

Wisconsin Department of Health Services Consumer Demand • Consumers are more savvy today. • Consumers demand quality. • Consumers seek resources and answers to important questions about long term care. 28

Wisconsin Department of Health Services Advocates • Assisted living growth is everywhere in this country, get involved and ask questions about the quality of life and care in your home states. • Utilize consumer voice as a resource and our WCCEAL Program. 29

Wisconsin Department of Health Services Competition • Raise the bar on quality. • Positioned to compete better in the marketplace. 30

Wisconsin Department of Health Services Regulations • Proactive approach to regulatory compliance • Sustained regulatory compliance • Regulatory relief: o If qualified, then less frequent surveys 31

Wisconsin Department of Health Services Insurance Companies • Decrease risk • Increase ability to obtain and retain liability insurance • Discounts and reduced premiums 32

Wisconsin Department of Health Services CMS Guidelines to the States for Home and Community. Based (HCBS) waivers • Greater emphasis on quality • Sections 1915 (c), (i) and (k) of the Act all require states to demonstrate at the time of approval that they have a quality improvement strategy that includes performance and outcome measures for the Medicaid Home and Community Based Services (HCBS) waivers. 33

Wisconsin Department of Health Services CMS Guidelines to the States for HCBS waivers (cont’d) In Wisconsin, 51 percent of Family Care service expenditure was for AL (Residential Care Apartment Complexes (RCAC), Community-Based Residential Facilities (CBRF), and adult family homes (AFH)). Thirty -nine percent of enrollees had some service cost during the year for AL. 34

Wisconsin Department of Health Services National Quality Forum Measuring HCBS Quality http: //www. qualityforum. org/Measuring_HCBS_Quality. aspx This project developed a conceptual framework and performs an environmental scan to address performance measurement gaps in home and community-based services to enhance the quality of community living. • Create a conceptual framework for measurement, including a definition for HCBS. • Perform a synthesis of evidence and environmental scan for measures and measure concepts. • Identify gaps in HCBS measures based on the framework. • Make recommendations for HCBS measure development efforts. 35

Wisconsin Department of Health Services Government Oversight and Support for Quality Program Enforcement QA & QI Nursing Home Federal Regulations ✔ ✔ State Regulations ✔ ✔ Quality Improvement Organization (QIO) ✔ ✔ Advancing Excellence ✔ ✔ Nursing Home Quality Initiative ✔ ✔ AHRQ Nursing Home Consumer Assessment of Healthcare Providers and Systems (CAHPS) ✔ ✔ Medicare Quality Improvement Community (QIES) ✔ ✔ Nursing Home Compare – 5 Star ✔ ✔ Minimum Data Set ✔ ✔ Quality Assurance Performance Improvement (QAPI) ✔ ✔ Online Survey , Certification and Reporting (OSCAR) ✔ ✔ Wisconsin Coalition for Collaborative Excellence in Assisted Living (WCCEAL) ✔ Assisted Living ✔ ✔

Wisconsin Department of Health Services Wisconsin Partnership Program (WPP) Grant WCCEAL awarded five-year $1, 000 grant to expand current WCCEAL efforts and to establish a comprehensive and robust quality infrastructure for Wisconsin assisted living centers (ALCs). This project has five specific aims: 1. Expand the reach of WCCEAL by working with our support community partners to implement specific strategies to expand active participation by Wisconsin ALCs. 2. Improve the WCCEAL data infrastructure to enable ALC to make data driven quality improvement decisions. 37

Wisconsin Department of Health Services WPP Grant (cont’d) 3. Evaluate and assess how to integrate WCCEAL participation into the Division of Long Term Care Family Care Quality Strategy. 4. Establish quality improvement collaboratives and informational resources to support ALCs in targeting and improving their individual quality performance. 5. Assess the impact of WCCEAL participation on changes in quality indicators and in regulatory enforcement outcomes. 38

Wisconsin Department of Health Services WCCEAL Demographics As of 12/31/2015 39

Wisconsin Department of Health Services Current Projects • • • Implement five aims of the WPP grant Fall prevention grant Music & Memory plus i. Pad grant Secretary Rhoades Music & Memory grant Early adopter study Continued talks with AMDA (The Society for Post. Acute and Long-Term Care Medicine) 40

Wisconsin Department of Health Services Next Steps: WCCEAL • Expand the model: o Add more outcomes o Additional learning modalities • Potential expansions to other states • Collaboration with national organizations (Assisted Living Federation of America (ALFA), National Center for Assisted Living (NCAL), Leading. Age, Consumer Voice, National Ombudsman Resource Center, Administration for Community Living) 41

Wisconsin Department of Health Services AL Quality Collaborative Model Quality Improvement Supports Information Disseminatio n Quality Improvement Measures and Reports Assisted Living Community Certification 42

Wisconsin Department of Health Services AL Quality Collaborative Model with External Partners Assisted Living Communities Quality Improvement Supports Provider Associations Researchers Regulatory Entities Information Disseminatio n Managed Care Organizations Quality Improvement Measures and Reports Public Funding Agencies Advocates Assisted Living Community Certification 43

WCCEAL Demo - Visitor Login Process https: //wcceal. chsra. wisc. edu/ Username: wccealvisitor New password is: armadillo 123 44

Wisconsin Department of Health Services Questions and Answers Contact information Heather Bruemmer, Executive Director/State Ombudsman Wisconsin Board on Aging and Long Term Care Heather. Bruemmer@wisconsin. gov 1 -800 -815 -0015 Kevin Coughlin, Executive Policy Initiative Advisor Department of Health Services Kevin. Coughlin@dhswisconsin. gov 608 -266 -6989 45