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The HHQI National Campaign Phase 3

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

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The HHQI National Campaign Phase 3

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  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. Medicare’s 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/GettingCare/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 RateParticipants 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

  24. Comparison of Campaigns

  25. Network Development Committee Network Coordinators Grassroots Networks 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 Isn’t 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 cschade@wvmi.org

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