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The HHQI National Campaign Phase 3

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The HHQI National Campaign Phase 3 Looking Forward and Building on Past Successes Charles P. Schade, MD, MPH West Virginia Medical Institute – PowerPoint PPT presentation

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Title: The HHQI National Campaign Phase 3


1
The HHQI National Campaign Phase 3
Looking Forward and Building on Past Successes
Charles P. Schade, MD, MPH West Virginia Medical
Institute
2
Disclaimer
  • The analyses upon which this publication is based
    were performed under Contract Number
    HHSM-500-2011-WV10C, funded by the Centers for
    Medicare Medicaid Services, an agency of the
    U.S. Department of Health and Human Services. The
    content of this publication does not necessarily
    reflect the views or policies of the Department
    of Health and Human Services, nor does mention of
    trade names, commercial products, or
    organizations imply endorsement by the U.S.
    Government. The authors assume full
    responsibility for the accuracy and completeness
    of the ideas presented. Publication number
    10SOW-WV-HH-BK-8.15.12. App. 8/2012.

3
Acknowledgements
  • Co-authors of HHQI-2 report
  • Shanen Wright
  • Bethany Knowles
  • Karen Hannah
  • Eve Esslinger
  • WVMI/QI analytic staff
  • Jill Manna
  • Yinghua Sun
  • John Bowers
  • Cynthia Pamon, Government Task Leader
  • Almost 5,000 participating HHAs

4
Outline
  • HHQI National Campaigns 1 and 2
  • Changes in HHQI Campaign 3
  • How we will evaluate it
  • How you can help

5
Introduction
  • 12 million individuals received home health care
    in 2010 from 33,000 providers
  • Medicare providers are approximately 1/3 of the
    total
  • Medicare (41) and Medicaid (24) paid
    approximately 2/3 of cost of home health services
    in 2009

6
Recent Growth of Medicare Home Health Services
Source CMS, Medicare Home Health Agency
Statistical Summary 2011
7
Medicares Take on Home Health
  • Home health care is a wide range of health care
    services that can be given in your home. Home
    health care is usually less expensive, more
    convenient, and just as effective as care you get
    in a hospital or skilled nursing facility.
  • The goal of home health care is to treat an
    illness or injury. Home health care helps you get
    better, regain your independence, and become as
    self-sufficient as possible.
  • In general, home health care includes part-time
    or intermittent skilled nursing care, and other
    skilled care services like physical therapy,
    occupational therapy, and speech therapy.
    Services may also include medical social services
    or assistance from a home health aide. Usually, a
    home health care agency coordinates the services
    your doctor orders for you.

Source CMS, Home Health Compare
http//www.medicare.gov/homehealthcompare/About/Ge
ttingCare/WhatisHomeHealthCare.aspx
8
Medicare Home Health Services Opportunities for
Improvement
  • 27 of patients were admitted to the hospital
    from home health care
  • 48 of patients improved self-administration of
    drugs during home health care
  • 57 of patients got better at walking or moving
    around during home health care

Source Home Health Compare, national outcome
data covering April 2011-March 2012
9
Outline
  • HHQI National Campaigns 1 and 2
  • Changes in HHQI Campaign 3
  • How we will evaluate it
  • How you can help

10
HHQI National Campaign 1 (2007)
  • Collaboration of QIOs, state associations,
    national organizations
  • Almost 5,600 Medicare Certified HHAs
    participating
  • Over 9,600 continuing education participants
  • QIOs and state-level projects
  • ACH-focused
  • Data feedback and intervention packages

11
Acute Care Hospitalization Rate Participants and
Non-Participants
12
Percent of Agencies Using Specific BPIPs and
Improvement in ACH
Best Practice Intervention Packages Acute care
hospitalization during home care
13
Summary Findings HHQI 1
  • Decline in ACH masked by changes in ALOS
  • Agencies that improved used more campaign tools
  • On average, agencies used 3-5 intervention
    packages
  • The campaign was cost effective

Average length of service
14
Lessons Learned HHQI 1
  • Focus on fewer packages
  • Address management concerns
  • Statewide involvement
  • Success stories help
  • Multiple channels for education
  • User instruction on BPIPs

15
HHQI National Campaign 2 (2010-2011)
  • 4,721 (43 of all HHAs) registered for the
    campaign
  • Potentially impacted about 3 million home health
    patients
  • Focus on ACH, medications, disparities
  • BPIPs broader, less frequent
  • National scope, social media
  • Data feedback continued and expanded

16
Acute Care Hospitalization Rate
BPIP released
17
Medication Management Improvement
BPIP released
No data due to OASIS-B to OASIS-C conversion
18
Changes in ACH and ALOS by Participation
Intensity Quartile
Average length of service for home health
patients in agency
19
Cost Implications
Project cost 1.4 million
Project cost equivalent to 127 admissions
Average Medicare hospital admission cost 11,000
195 HHAs in top 2 partici- pation quartiles
averaged 1,600 episodes/year
1,560 fewer readmissions than expected
These HHAs reduced hospital admissions 0.5 more
than lower groups
20
Summary Findings HHQI 2
  • Campaign was successful, engaging nearly 5,000
    home health agencies
  • Agencies used campaign materials and many adopted
    recommended practices
  • Quality of care measures improved
  • Acute care hospitalization
  • Medication self-management
  • Participation intensity linked with improvement

21
New Initiatives for HHQI 3
  • Understanding and addressing health care
    disparities
  • Reaching smaller agencies
  • Accelerating improvement

22
Outline
  • HHQI National Campaigns 1 and 2
  • Changes in HHQI Campaign 3
  • How we will evaluate it
  • How you can help

23
Comparison of Campaigns
Attributes Phase 1 2007-2008 Phase 2 2010-2011 Phase 3 2012-2014
Duration 12 Months 18 Months 22 Months
Theme ACH Reduction ACH Reduction, Improvement of Oral Medication ACH Reduction, Improvement of Oral Medication, Immunizations
Customized Data Reports Via USPS Mailing Via Secure Electronic Transmission Via Secure Electronic Transmission with Raw and Risk-Adjusted Data
Participant Communication State-based QIOs HHQI Contractor Team HHQI Contractor Team and Grassroots Networks
Local Area Networks for Excellence (LANEs) QIOs and State Associations QIOs, State Associations and Corporate Leaders The HHQI Network
24
Comparison of Campaigns
Attributes Phase 1 2007-2008 Phase 2 2010-2011 Phase 3 2012-2014
Primary Resource Best Practice Intervention Packages (BPIPs) BPIPs BPIPs and Focused BPIPs
Other Resources None Webinar Education and Participant Social Networking Webinar Education Plus Virtual and Grassroots Social Networking
BPIP Publication Monthly Quarterly Periodically Per Online Schedule
Cost to Participate Free Free Free
Cross-Setting Focus Limited Extensive Extensive
Special Populations Focus None Limited Extensive
25
New Organization of Local Activities
26
More Emphasis on Eliminating Health Care
Disparities
Acute Care Hospitalization Rate Medicare Home
Health Patients, 2010
27
More Topics for Interventions
  • Flu and pneumonia immunizations
  • Receipt of vaccine, not just advocacy
  • Dual eligible beneficiaries
  • Focused interventions

28
More Improvement
29
Outline
  • HHQI National Campaigns 1 and 2
  • Changes in HHQI Campaign 3
  • How we will evaluate it
  • How you can help

30
Evaluation Topics HHQI 3
  • Extent and intensity of home health agency
    participation in the campaign
  • Participating agencies satisfaction with
    campaign materials and activities
  • Improvement in campaign-related outcomes among
    patients of agencies participating in the
    campaign
  • Reduction in disparities in health outcomes
    across racial groups and between dual eligible
    and non dual eligible patients of agencies
    participating in the campaign.

31
Outcome Measures
  • Acute care hospitalization
  • Improvement/stabilization in medication
    management
  • Pneumonia immunization
  • Influenza immunization
  • Emergency department utilization (maybe)

32
Identifying and Reducing Disparities in Outcomes
  • By race
  • By gender
  • By dual eligible status
  • By agency size

33
Process Measures I
  • Agency enrollment in campaign
  • Agency downloads of campaign materials
  • Number of HHQI Network Coordinators recruited
  • Agency enrollment in HHQI Networks
  • HHQI Networks-number of participating agencies
  • HHQI Networks-meetings/events held

34
Process Measures II
  • Agency extent of use of campaign materials
  • Agency satisfaction with campaign materials
  • Agency extent of participation in HHQI Networks
  • Participation in national Web events
  • Agency satisfaction with HHQI Networks
  • Agency satisfaction with outcomes feedback reports

35
Just Downloading Isnt Enough
36
Linking Processes with Outcomes
  • Agencies with more intense involvement in
    grassroots networks
  • Agencies with more use of best practices
  • Agencies with greater satisfaction with campaign
    resources

37
Issues
  • Externalities
  • Respondent fatigue
  • How to engage smaller agencies
  • Larger changes sustaining change

38
Outline
  • HHQI National Campaigns 1 and 3
  • Changes in HHQI Campaign 3
  • How we will evaluate it
  • How you can help

39
Four ways you can help the campaign succeed
  • Develop and test better interventions
  • Simple but effective interventions for small
    agencies
  • Research to help us understand causes of
    disparities
  • Organize or join a network
  • Support cross institutional approaches to
    improving care transitions

40
Questions? Comments?
Thank you for coming to this presentation.
Contact information www.homehealthquality.org csc
hade_at_wvmi.org
41
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