HIV/AIDS Bureau
Division of State HIV/AIDS Programs (DSHAP)
Ryan White HIV/AIDS Program Part B
Technical Assistance Webinar
Building a Quality Management Program
January 15, 2014
DSHAP Mission
To provide leadership and support to
States/Territories for developing and
ensuring access to quality HIV prevention,
health care and support services.
2
Agenda
Opening Remarks/ Announcements
Heather Hauck
Question and Answer
Report on DSHAP’s 2013 Webinars
Katherine Patterson,
Magnus Azuine
The Ryan White HIV/AIDS Program Moving
Forward – Quality Initiatives
Heather Hauck
Clinical Quality Management
Susan Robilotto
Georgia Quality Management Program
Eva Williams
Questions and Answer
Closing Remarks
Heather Hauck
3
Presenter
Heather Hauck
Director
Division of State HIV/AIDS Programs
4
Announcements
& Updates
5
Announcements
FY14 RWHAP Part B Base/ADAP Earmark (X07) Awards
Important Deadlines:
• The due date for the next X07 ADAP Quarterly Report (AQR)
Submission (for the 10/1/13-12/31/13 reporting period) is
1/31/2014.
• The AQR is being phased out. 4/30/14 will be the last AQR
grantees will be required to submit.
• Unobligated Balances (UOB) Estimated Carryover: due January
31, 2014
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2013 Ryan White RSR and ADR
Submission Timelines
Date
Monday, December 2, 2013
RSR
Grantees
RSR Provider Report Start Date
System opens for providers to begin
work on their RSR Provider Reports
and upload their client-level data
files.
RSR Grantee Report due date
All RSR Grantee Reports must be in
“Certified” status. After this deadline,
grantees must contact Data Support
to certify or to make changes to their
RSR Grantee Reports.
Monday, March 3, 2014
Monday, March 10, 2014
Monday, March 24, 2014
Monday, March 31, 2014
6:00 p.m. ET
Thursday, April 10, 2014
Monday, June 9, 2014
6:00 p.m. ET
ADR
RSR Grantee Report Start Date
System opens for grantees to begin
work on their RSR Grantee Report.
Monday, January 6, 2014
Monday, February 3, 2014
6:00 p.m. EST
Providers
2013 ADR Client XML Test Site
Opens
Target date for the submission of all
RSR Provider Reports and client-level
data. RSR Provider Reports should be
in “Review” or “Submitted” status.
Return for Changes deadline
Last day for grantees to return RSR
Provider Reports and client-level data
to their providers for changes or
corrections.
All RSRs must be in “Submitted”
All RSRs must be in “Submitted”
status by 6:00 PM ET.
status by 6:00 PM ET.
ADR Web System Opens for
2013 Data Collection
2013 ADR is Due to HRSA
7
New SPNS FY 14 FOAs Released:
• System-level Workforce Capacity Building for Integrating HIV
Primary Care in Community Health Care Settings –
Demonstration sites HRSA 14-055
• Deadline: March 10, 2014
• System-level Workforce Capacity Building for Integrating HIV
Primary Care in Community Healthcare Settings – Evaluation
and Technical Assistance – HRSA 14-058
• Deadline: March 10, 2014
• HRSA/HAB will host a technical assistance (TA) webinar
Wednesday, January 29, 2014 from 2:00 – 4:00pm EST (HRSA14-055) and Thursday, January 30, 2014 from 2:00 – 4:00pm
EST (HRSA-14-058) Register http://careacttarget.org/events
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Questions
9
A Review of DSHAP’s 2013 Webinars
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Respondents
11
Number of Years in Position
12
Topics of Interest
Healthcare Reform in States
28%
2013 Reauthorization
24%
National Monitoring Standards
18%
Early Intervention Services and working with CDC/ 6%
ADAP Eligibility, Enrollment and recertification
National HIV AIDS Strategy/ HAB Performance
Measures/Quality Management Plans/Insurance
continuation through ADAP
Maintenance of Efforts/Pharmacy Benefits
Management overview and how to work with
PBMs
4%
2%
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DSHAP 2013 Webinars
January 30, 2013
ADAP and Federal PCIP Coordination
February 13, 2013
2013 TA Webinars Feedback and Part B Program Updates
March 26, 2013
Clarifications on Client Eligibility Assessment and Recertification
Requirements
April 30, 2013
Carryover Requests and Federal Financial Reports (FFR): Tracking
and Reporting of Rebates
June 11, 2013
National Monitoring Standards Update and Schedule of Charges
June 26, 2013
FY 2013 Part B Supplemental Funding Opportunity
Announcement (FOA) and the ADAP ERF FOA
October 10, 2013
FY 2014 Ryan White HIV/AIDS Program Part B /ADAP Earmark
Funding Opportunity Announcement
October 31, 2014
ADAP ERF 2014 FOA
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NASTAD Cooperative Agreement
March 2013
ADAP Crisis Lessons Learned
March 2013
Financial Forecasting Part One
May 2013
Financial Forecasting Part Two
May 2013
ADAP and Health Reform
June 2013
ADAP and Insurance
September 2013
ADAP Application and Coordination with ACA
October 2013
Plan Assessment
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Other HAB Sponsored Webinars
• August 14, 2013; “Preparing for 2014: Overview of Ryan White
HIV/AIDS Part B Program policy updates and guidance” sponsored
by HAB
• August 29, 2013; “Better Together: State Strategies for MedicaidRyan White HIV/AIDS Program Coordination” sponsored by
National Academy of State Health Policy through its cooperative
agreement with HRSA
• November 20, 2013; “The Ryan White Program and Understanding
Modified Adjusted Gross Income (MAGI)” sponsored by the
HIV/AIDS Bureau in partnership with the CMS.
• December 4, 2013; “The Ryan White HIV/AIDS Program in States
Not Expanding Medicaid” sponsored by HIV/AIDS Bureau
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Grantee Topics Completed
Healthcare Reform in States
2013 Reauthorization
National Monitoring Standards
Early Intervention Services and working with CDC
ADAP Eligibility, Enrollment and recertification
National HIV AIDS Strategy
Quality Management Plans
Insurance continuation through ADAP
HAB Performance Measures
Pharmacy Benefits Management overview; how to
work with PBMs
Maintenance of Effort
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Additional Topics
• Cap on charges & sliding fee scales
• Role of case managers in outreach and
enrollment in Marketplace
• Impact of ACA on Ryan White
• Ryan White Services Report
• Implementation of insurance continuation
programs & ACA
• Quality Management Plans
• ADAP Data Report (ADR)
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How Did We Do?
• The division met and exceeded it’s goal
• 54% of grantee topics addressed
• A total of 19 technical assistance
webinars completed. An increase of
130%!
19
2014 Webinar Evaluation
Option 1
Option 2
Kpatterson@hrsa.gov
mazuine@hrsa.gov
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Building a Quality
Management Program
Building a Quality Management
Program
HAB Expectations
Heather Hauck, MSW, LICSW
Director
Division of State HIV/ AIDS Programs
Objectives
 HAB expectations for a Quality Management
Program
 Components of a Quality Management Program
 Grantee Presentation
Zero New
Infections
 The Ryan White Program funds comprehensive HIV care systems
for low-income individuals and families to reduce new HIV
infections, to improve health outcomes for PLWH, and to reduce
HIV-related health disparities.
 HAB ensures the maximum effectiveness of the Ryan White
Program by assessing the HIV care and service needs of PLWH,
shaping HIV policy, assessing models of care and services
required, providing target training of the health care workforce,
providing leadership on national HIV/AIDS quality measures.
Quality
 Empower stakeholders to deliver high quality HIV
care and treatment across the nation.
 Establish and monitor key HIV quality
measures/indicators to assure high-quality care that
address all stages of the care continuum and adhere
to DHHS standards.
 Collect, analyze, and utilize data on health outcomes
of PLWHA to improve and advance the treatment of
care.
Quality
 HAB advances evidence-based, cost effective HIV care and
treatment through the provision of training and capacity
development grants and cooperative agreements.
 HAB provides leadership on national HIV/AIDS quality measures,
including the development, alignment among HHS OPDIVS and
other federal agencies and adoption of these measures by Ryan
White clinical providers.
 HAB promotes clinical quality improvement by HAB staff and
grantees through capacity development, monitoring grant activities
and implementing special projects and studies.
Components of a Quality
Management Program
Susan Robilotto, D.O.
Clinical Consultant
Division of Metropolitan HIV/AIDS Programs
Division of State HIV/AIDS Programs
Ryan White HIV/AIDS Treatment Extension Act
All Ryan White grantees are required to establish clinical
quality management programs to:
Evaluate
Improve
• Assess the extent to which HIV health
services are consistent with the most
recent Public Health Service guidelines
for the treatment of HIV disease and
related opportunistic infections; and
• Develop strategies for ensuring that
such services are consistent with the
guidelines for improvement in the
access to and quality of HIV services
Programmatic Expectations

Funding Opportunity Announcement
provides minimum expectations for
grantees.



Established and implemented a clinical quality
management plan;
Established processes for ensuring that Primary
Medical Care services are provided in accordance with
the Department of Health and Human Services
(DHHS) treatment guidelines and standards of care;
and
Incorporated quality-related expectations into
Requests for Proposals (RFP) and contracts.
Components of a QM Program
 Quality Infrastructure
 Quality Management Plan
 Performance Measures
 Quality Improvement Projects
Quality Infrastructure
 Infrastructure enhances systematic implementation
of improvement activities.
Infrastructure
Quality Infrastructure
 Quality Management Committee
 Leadership
 Stakeholders
Quality Management Committee
 Builds the HIV program’s capacity and capability for
quality improvement
 Involves program leaders and other key staff to
cement their personal commitment to quality
 In a large organization, links the HIV quality program
with the organization’s overall quality program
Who might be on the committee?
For a Teaching Hospital
(HIV case load: 700)
• Chief of Infectious
Diseases
• AIDS Center Administrator
• Director of Ambulatory
Care
• Director of Quality
Improvement
• Director of Nursing
• AIDS Center Nurse
Practitioner
• Clinic Coordinator for
Case Management
• Senior Staff Nurse
• Patient Representative
• Part D Provider
For a Community Health
Center
(HIV caseload: 100)
• Medical Director
• Senior Staff Nurse
• HIV Nurse
• Case Manager
• Patient Representative
For a Network (State
jurisdiction)
(HIV case load: 20,000)
• Ryan White Program
Coordinator
• State AIDS Director
• Medical Director
• Quality
Manager/Contractor
• Medicaid
• CDC Prevention
• Part C or Part D contractor
• Subcontractors (Case
Manager, housing, food
bank, etc.)
• Patient Representative
Leadership
 Clearly articulated mission and vision statement
 Ongoing measurement of performance
 Ongoing assessment by leaders
 Active coaching by leaders
Stakeholders
 How will staff, providers, consumers and
others be involved in the CQM program?
• Engage internal and external
stakeholders
• Communicate information about quality
improvement activities
• Provide opportunities for learning about
quality
Quality Management Plan
 A quality management plan is a written document
that outlines the grantee-wide HIV quality program,
including a clear indication of responsibilities and
accountability, performance measurement strategies
and goals, and elaboration of processes for ongoing
evaluation and assessment of the program.
 Updated quality management plans are going to be
requested from all Part B grantees in FY14
Quality Management Plan of a Quality
Management Plan
1. Quality statement
2. Quality infrastructure
3. Performance measurement
4. Annual quality goals
5. Engagement of stakeholders
6. Evaluation
The 10 QM Plan Rules
1. Do not reinvent the wheel, use established
frameworks to get started
2. ‘Steal Shamelessly, Share Senselessly’
3. Size does not matter
4. 80% planning, 20% writing (old software
programming rule)
5. A few visionary annual goals are better than plenty
of useful ones
The 10 QM Plan Rules (cont.)
6. Be inclusive, even if it takes longer to get your final
QM plan
7. If you have not touched your plan in the last 6
months, bring it to the next quality committee
meeting
8. A perfect plan is never written
9. Plans are only as good as their implementation
10. Get started
Performance Measures
Importance of Performance Measures:
 Separating what you think is happening from what is
really happening
 Establishing a baseline and allowing for periodic
monitoring
 Determining whether changes lead to improvements
 Comparing performance with others
 Linking performance data to quality improvement
activities
HAB Performance Measures
 2007: Started developing and releasing measures
under the guidance of Dr. Cheever
 Currently 46 measures spanning clinical care, oral
health care, ADAP, case management, and systems
 Alignment and streamline measure across federal
programs
 Core measures received National Quality Forum
endorsement in February 2013
 http://hab.hrsa.gov/deliverhivaidscare/habperformme
asures.html
Quality Improvement Projects
Imbalance
Balance
Quality Improvement Projects
PDSA Cycle
Quality Management Program
 QM Program evaluation tool
– Developed to help project officers and consultants to better
evaluate QM Programs during site visits
– Identify if a program is meeting legislative requirements
– Identify areas in which a program has established “best
practices”
– Identify areas where a program needs to improve in order to
provide a high quality system of care
Quality Management Program
Resources:
 National Quality Center (NQC)
http://nationalqualitycenter.org/index.cfm
 NQC Quality Academy
http://nationalqualitycenter.org/index.cfm/5847/8860
 HIV/AIDS Bureau (HAB) Performance Measures
http://hab.hrsa.gov/deliverhivaidscare/habperformm
easures.html
Georgia Department of Public Health
Ryan White Part B
Quality Management Program
HRSA TA Webinar
Building a Quality Management Program
January 15, 2014
3:00 – 4:00 PM
Acknowledgments
•
•
•
•
•
•
•
•
•
•
•
Rosemary Donnelly, SEATEC Clinical Director
Pamela Phillips, RW Part B QM Coordinator
Michael Coker, RW Part B HIV Nurse Consultant
Rachel Powell, RW Part B QM Data Manager
Marisol Cruz, RW Part B Care Manager
William Lyons, HIV Office Director
Kim Brown, HRSA Project Officer
RW Part B QM Core Team and Subcommittees
National Quality Center
RW Part B-funded health district staff
Representatives/Grantees of other Georgia RW Parts
RW Part B QM Team Structure
HIV Medical
Advisor
HIV Office
Director
RW Part B Care
Manager
HIV Prevention
Manager
QM Team Lead
HIV Nurse
Consultant
Quality
Management
Coordinator
HIV Nurse
Consultant
Part-Time Data
Manager
Part B-Funded Health Districts
1-1
1-2
3-1
3-3
3-4
4-0
5-1
5-2
6-0
7-0
8-1
8-2
9-1
9-2
10-0
Rome
Dalton
Cobb-Douglas
Clayton
East Metro
LaGrange
Dublin
Macon
Augusta
Columbus
Valdosta
Albany
Brunswick/Savannah
Waycross
Athens
**3-2 Fulton and 3-5 DeKalb
are funded primarily by Part A
Origins of the QM Program
• 1990’s: Nurse consultant for HIV Prevention
asked to assist with quality reviews for
medical care
– HIV Medical Advisor hired 2000
• 2005: Title II Collaborative with HRSA/NQC
–
–
–
–
–
18 months of TA and support
Developed written QM Plan
Created statewide QM Committee
Additional QM staff hired
Improved buy-in from all stakeholders
Elements of Current Structure
• Georgia RW Part B Program QM Plan
• Statewide QM Core Team and
Subcommittees
• Expectations for funded health districts
• Data Collection, Reporting and Analysis
Georgia RW Part B QM Plan
Communication &
Coordination
QM Core Team &
Subcommittees
Capacity Building
(Training and TA)
Part B
QM Plan
Local QM Plans &
Annex-GIA
Data Collection
Continuous
Quality Improvement
(CQI) Projects
Evaluation
Georgia RW Part B QM Plan
• Implemented April 1 – March 31, updated
annually
• Process to evaluate and revise:
– Meetings with stakeholders
– Review quality data
– NQC Assessments
– Federal initiatives
– Approval by QM Core Team and HIV Office
Director prior to implementation
Statewide RW Part B QM Core Team
• Purpose: To provide oversight and
facilitation of the GA RW Part B QM Plan
• Meetings are held quarterly, face-to-face
preferred in a central location for the state
• Composed of multidisciplinary
professionals and consumers
– Subcommittees: Case Management,
ADAP/HICP
– Collaboration with other RW Parts
Funded Health District QM Expectations
• Ensure compliance with DHHS-related
guidelines
• Participate in statewide Part B QM Program
• Develop and implement local QM Program
–
–
–
–
Written QM Plan and work plan updated annually
Leader and team to oversee the Program
QM Goals, objectives and strategies
Communicate results to all levels of the
organization, including consumers as appropriate
Quality Data Collection and Reporting
• Collaborate with Epi/Surveillance
• Surveys, e.g. statewide Client Satisfaction Survey
• Clinical and Case Management Chart Review
– Reliable
– Limitations in how the data is collected
– Time and resource intensive
• CAREWare
– Uniform comparison based on data that is entered
– Includes all eligible clients
– Generally less reliable for some measures and districts
Overview of a CQI Project
• Clinical chart reviews were conducted in 2006
• Two areas of improvement were found: dental exam
and cervical cancer screening
• Districts not at goal were asked to incorporate these
measures into their local QM Plans
• Improvement projects occurred at both the state and
local levels
• In 2009, clinical chart review showed modest
improvement in both measures
• Currently, clinical chart review data is being analyzed
for CY2012. The data will be compared with 2006 and
2009 to determine trends and next steps
CQI Project Data
Recent Projects
Statewide client satisfaction survey
In+Care Campaign
Collaboration with Medicaid
Case Management Acuity Scale and Self
Management Model
• ADAP/HICP CAREWare electronic application
process
• Providing quality-related trainings and
technical assistance
•
•
•
•
Challenges/Opportunities for
Improvement
• Time frame for reporting data back to
stakeholders
• Innovative ways to improve CAREWare
data entry
• Case management training disparity
• Technical capacity
Building a Program: Where to Begin?
• National Quality Center trainings and TA
• Peer learning
• Obtaining buy-in from senior leadership
and stakeholders
• Using tools from NQC outlining what a
quality program should look like
– Written QM Plan
– QM Committee
– Process for data collection and reporting
Keeping the Program Strong
•
•
•
•
•
•
•
National Quality Center Trainings and TA
Buy-in is an ongoing process
Demonstrating the value of quality work
Listening to stakeholders
Being visible in the community
Always working to improve
Maintaining continuity through a detailed
QM Plan and documentation of meetings and
activities
Contact Information
• Eva B. Williams, MSN, FNP, MPH, AACRN
HIV Nurse Consultant – QM Team Lead
Phone: (404) 657-3113
Email: ebwilliams@dhr.state.ga.us
• Michael (Mac) Coker, MSN, RN, ACRN
HIV Nurse Consultant
Phone: (404) 463-0387
Email: macoker@dhr.state.ga.us
• Pamela Phillips, BSW, MHA
Quality Management Coordinator
Phone: (404) 657-8993
Email: pmphillips@dhr.state.ga.us
Questions
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