What is QuILTSS ?

1. A Training Program for LTSS ProvidersPart One: Quality Improvement in Long-Term Services and Supports (QuILTSS) Bridge Payment Submission

2. A TennCare initiative to promote the delivery of high quality LTSS for TennCare members (NF as well as HCBS) Identify performance measures that are most important to people who receive LTSS and their families Creation of a new payment system (aligning payment with quality) for NFs and certain HCBS based on performance on those measures What is QuILTSS? Part One: QuILTSS Overview

3. A Definition of Quality in LTSS: Providing the right carein the right placeat the right time—with the best possible outcome that helps people live the lives they want to live Part One: QuILTSS Overview

4. The QuILTSS Journey • Technical Assistance Report • Click here to access full report • Stakeholder input • Literature review • Key informant interviews • Recommendations • Quality Framework Stakeholder Meetings • Convened twice a month for three months Part One: QuILTSS Overview

5. Framework Contributors • Tennessee Health Care Association • LeadingAge Tennessee • National HealthCare Corporation • Signature HealthCARE • Tennessee Association for Home Care • AARP • Alzheimer’s Tennessee, Inc. • Tennessee Council on Developmental Disabilities • Tennessee Disability Coalition • The Arc Tennessee • Qsource • Tennessee Department of Health • Tennessee Commission on Aging and Disability • Area Agencies on Aging and Disability • Alexian Brothers Community Services (PACE) • Lipscomb University School of TransformAging Part One: QuILTSS Overview

6. Part Two: The QuILTSS Nursing Facility Value-Based Purchasing Quality Framework • Framework sent to Medicaid NF Providers on August 5, 2014 by Patti Killingsworth • Click to access memo and framework Part Two: Quality Framework

7. Value-Based Purchasing • Threshold Measures • Must be met by the facility in order to be eligible for the quality payment portion of their reimbursement rate • Quality Measures • Used to determine the amount of quality payment that a facility would receive Part Two: Quality Framework

8. Value-Based Purchasing Model Part Two: Quality Framework

9. Flexibility for Adjustmentsto Model’s Design • Anticipate adjustments will be made over time • Based on experience, system-wide performance, stakeholder feedback, and priorities • Expect to see changes to threshold and quality measures, categories, elements, definitions, benchmarks and point values Part Two: Quality Framework

10. Calculating Payment for Quality Portion of Rate Total number of points earned on all quality measures Divided by the total possible number of points Equals percentage of quality payment eligibility Part Two: Quality Framework

11. Implementation: Two Phase Process Transition/Bridge Model Value-Based Purchasing Model Full implementation of acuity- and quality-adjusted reimbursement rates is expected to begin during FY 2016 Part Two: Quality Framework

12. Bridge Model • Periodic interim payments to NFs to adjust the existing cost-based NF rates based on two acuity-based case-mix approaches and a 20% quality component, using an abbreviated version of the quality framework • Transitional - recognize efforts toward quality improvement and quality performance Part Two: Quality Framework

13. Bridge Model • Aligned as closely to value based purchasing model as possible • No threshold measures • Encourage participation • Increase quality improvement initiatives • Quality measures will be explained in greater detail in Parts 4-8 of training materials Part Two: Quality Framework

14. Beginning the training with the end in mind. Part Three: Brief Overview of the Submission Process Part Three: Submission Process

15. Organizing Your Submission 18 Possible Attachments Part Three: Submission Process

16. What You Need • Reliable Internet Access • Form is available online at https://tenncare.wufoo.com/forms/quiltss-bridge-payment-for-nursing-facilitiesq1/ • Write this link down for future reference • Click here for submission form • Print a copy of the submission form • Review it frequently to become familiar Part Three: Submission Process

17. Possible Attachments • Click here to access the “Survey Tool List of Attachments” • Print this list and follow it closely • Potential for 18 attachments • When preparing your submission, determine how many attachments you will submit. • If you want to submit multiple documents for a particular response, you must combine them into a single attachment. • Attachments must be titled correctly • For example, [facility name]2.pdf Part Three: Submission Process

18. Creating a PDF document • With one exception, attachments must be in .pdf format • If you have Adobe Acrobat on your computer, you should be able convert word or excel documents to pdf using the “save as” a pdf function. • Otherwise, you should consider downloading a pdf creator, pdf writer, or pdf printer software, that can allow you to create a pdf. • Many free software programs available online. Part Three: Submission Process

19. A Few Cautions to Keep in Mind • You must complete the submission form in one sitting, as you can not save and exit the form. • Important to attach the correct document during the submission process. • All submissions must be completed by the stated deadline so start preparing your submission immediately. Part Three: Submission Process

20. Deadlines • All submissions must be received before 4:30 p.m. central time on 9/15/14 • Late submissions will not be allowed. • Only one submission is allowed. • No modifications will be allowed to submissions, even if the modification could be made by the deadline. Part Three: Submission Process

21. Part Four: Documenting Quality Measures - Satisfaction Part Four: Documenting Quality Measures - Satisfaction

22. Satisfaction • Most important aspect of quality from the consumers’ perspective • Highest point value at 35 points • Comprised of three different perspectives on satisfaction: • Member/Resident • Family • Staff Part Four: Documenting Quality Measures - Satisfaction

23. What is a Member/Resident Satisfaction Survey? • Instrument designed to determine level of satisfaction with the services and supports provided by NF • Must have gathered information from member/resident’s perspective • Respondent could be the resident himself/herself, or their proxy • A member/resident satisfaction survey answered by a family member on behalf of the resident counts as a member/resident survey and not a family satisfaction survey Part Four: Documenting Quality Measures - Satisfaction

24. Member/Resident Satisfaction Did the facility conduct a member/resident satisfaction survey between July 1, 2013 and June 30, 2014? ASK Submit documentation and receive five points for the current quarter and every subsequent quarter of the bridge year for this measure. If Yes, Conduct a member/resident satisfaction survey during a subsequent quarter and receive points for the following quarters of the bridge year for this measure. If No, Part Four: Documenting Quality Measures - Satisfaction

25. Required DocumentationMember/Resident Satisfaction Survey • Create a pdf of a blank copy of the member/resident satisfaction survey • Title the document “[facility name]1.pdf” • Create a pdf of the survey results report • Title the document “[facility name]2.pdf” • You will also need: • Description of methodology for conducting survey • Sample size and number of respondents • How responses were gathered • Dates • Results of data analysis Part Four: Documenting Quality Measures - Satisfaction

26. If You Conducted a Survey… Did the facility utilize the results of the survey to pursue improved member/resident satisfaction? ASK Submit copy of documentation and receive ten points for current quarter. Each subsequent quarter will require documentation of improvement effortsoccurring during that time period. NFs do not have to pursue different and distinct areas of improvement each quarter. If Yes, Conduct a member/resident satisfaction survey and utilize the results to pursue improvement during the remaining subsequent quarters where documentation of new improvement efforts can be provided. If No, Part Four: Documenting Quality Measures - Satisfaction

27. Required DocumentationMember/Resident Satisfaction Improvement • Document showing NF pursued improvement in at least ONE area identified in the member/resident satisfaction survey as needing improvement • Example: Member/Resident Survey showed “staff teamwork” was a significant issue. NF launched a monthly training program on teamwork. • Must be during applicable time period • Create a pdf of a document • Title the document “[facility name]3.pdf” Part Four: Documenting Quality Measures - Satisfaction

28. Family Satisfaction Did the facility conduct a family satisfaction survey between July 1, 2013 and June 30, 2014? ASK Submit a copy of documentation and receive five points for the current quarter and every subsequent quarter of the bridge year for this measure. Submit a copy of documentation and receive five points for every quarter of the bridge year for this measure. If Yes, Conduct a family satisfaction survey during a subsequent quarter and receive points for the following quarters of the bridge year for this measure. If No, Part Four: Documenting Quality Measures - Satisfaction

29. What Counts as Family Satisfaction Survey? • Must be completed from the family member’s perspective • Specific to family’s experience and involvement • EX: Satisfaction with opportunities to participate in plan of care development, the facility’s communication with the family, the facility’s responsiveness to family complaints or concerns • NOT a member/resident satisfaction survey completed by a family member on behalf of the resident. Part Four: Documenting Quality Measures - Satisfaction

30. Required DocumentationFamily Satisfaction Survey • Create a pdf of a blank copy of the family satisfaction survey • Title the document “[facility name]4.pdf” • Create a pdf of the survey results report • Title the document “[facility name]5.pdf” • You will also need: • Description of methodology for conducting survey • Sample size and number of respondents • How responses were gathered • Dates • Results of data analysis Part Four: Documenting Quality Measures - Satisfaction

31. If You Conducted a Survey… Did the facility utilize the results of the survey to pursue improved family satisfaction? ASK Submit copy of documentation and receive five points for current quarter. Each subsequent quarter will require documentation of improvement effortsoccurring during that time period. NFs do not have to pursue different and distinct areas of improvement each quarter. If Yes, Conduct a family satisfaction survey and utilize the results to pursue improvement during the remaining subsequent quarters where documentation of new improvement efforts can be provided. If No, Part Four: Documenting Quality Measures - Satisfaction

32. Required DocumentationFamily Satisfaction Improvement • Document showing NF pursued improvement in at least ONE area identified in the family satisfaction survey as needing improvement • Example: Family Survey showed “communication between staff and family members ” was a significant issue. NF implemented new communication policies and procedures and trained staff on better methods of communication. • Must be during applicable time period • Create a pdf of a document • Title the document “[facility name]6.pdf” Part Four: Documenting Quality Measures - Satisfaction

33. Staff Satisfaction Did the facility conduct a staff satisfaction survey between July 1, 2013 and June 30, 2014? ASK Submit a copy of documentation and receive five points for the current quarter and every subsequent quarter of the bridge year for this measure. Submit a copy of documentation and receive five points for every quarter of the bridge year for this measure. If Yes, Conduct a staff satisfaction survey during a subsequent quarter and receive points for the following quarters of the bridge year for this measure. If No, Part Four: Documenting Quality Measures - Satisfaction

34. Required DocumentationStaff Satisfaction Survey • Create a pdf of a blank copy of the staff satisfaction survey • Title the document “[facility name]7.pdf” • Create a pdf of the survey results report • Title the document “[facility name]8.pdf” • You will also need: • Description of methodology for conducting survey • Sample size and number of respondents • How responses were gathered • Dates • Results of data analysis Part Four: Documenting Quality Measures - Satisfaction

35. If You Conducted a Survey… Did the facility utilize the results of the survey to pursue improved staff satisfaction? ASK Submit copy of documentation and receive five points for current quarter. Each subsequent quarter will require documentation of improvement effortsoccurring during that time period. NFs do not have to pursue different and distinct areas of improvement each quarter. If Yes, Conduct a staff satisfaction survey and utilize the results to pursue improvement during the remaining subsequent quarters where documentation of new improvement efforts can be provided. If No, Part Four: Documenting Quality Measures - Satisfaction

36. Required DocumentationStaff Satisfaction Improvement • Document showing NF pursued improvement in at least ONE area identified in the staff satisfaction survey as needing improvement • Example: Staff Survey showed “assistance with job stress” was a significant issue. NF conducted focus groups to better understand issue and to identify stressors. Then, they created a new program to assist staff in this area. • Must be during applicable time period • Create a pdf of a document • Title the document “[facility name]9.pdf” Part Four: Documenting Quality Measures - Satisfaction

37. Haven’t Measured Satisfaction? • Click here to access Advancing Excellence’s listing of “Survey Instruments Available for Measuring Satisfaction of Nursing Home Residents, their Family Members or Staff” • Please note that this is not an exhaustive listing of acceptable instruments, but directs facilities toward instruments that may be useful in their initial quality improvement efforts. Part Four: Documenting Quality Measures - Satisfaction

38. Part Five: Documenting Quality Measures- Culture Change/Quality of Life Part Five: Documenting Quality Measures – Culture Change

39. Culture Change/Quality of Life • Second most important aspect of quality from the consumers’ perspective • Significant point value at 30 points • Comprised of two different areas: • Person-centered/culture change (PC/CC) practices • Member/resident & family input Part Five: Documenting Quality Measures – Culture Change

40. What is a PC/CC Practices Assessment? • Assessment to determine whether care is being delivered in an individualized way based on the needs and preferences of each resident, and which supports each resident’s choice and autonomy. • Fundamental aspects include a “homelike” environment and care practices which support residents in exercising choice in their daily lives. Part Five: Documenting Quality Measures – Culture Change

41. How does it differ from satisfaction survey? • A culture change/person-centered practices assessment evaluates various aspects of the facility environment, care practices for all residents, the facility’s staffing practices, and opportunities for family and community involvement. Part Five: Documenting Quality Measures – Culture Change

42. PC/CC Practices Assessment Did the facility conduct a PC/CC Practices Assessment between July 1, 2013 and June 30, 2014? ASK Submit copy of assessment and receive five points for the current quarter and every subsequent quarter of the bridge year for this measure. Submit a copy of documentation and receive five points for every quarter of the bridge year for this measure. If Yes, Conduct a PC/CC practices assessment during a subsequent quarter and receive points for the following quarters during the bridge year for this measure. If No, Part Five: Documenting Quality Measures – Culture Change

43. Required DocumentationPC/CC Practices Assessment • Create a pdf of a blank copy of the PC/CC Practices Assessment • Title the document “[facility name]10.pdf” • Create a pdf of the PC/CC Practices Assessment report • Title the document “[facility name]11.pdf” • You will also need: • Description of methodology for conducting survey • Sample size and number of respondents • How responses were gathered • Dates • Results of data analysis Part Five: Documenting Quality Measures – Culture Change

44. If You Conducted an Assessment… Did the facility utilize the results of the assessment to pursue improved PC/CC practices? ASK Submit copy of documentation and receive ten points for current quarter. Each subsequent quarter will require documentation of improvement effortsoccurring during that time period. NFs do not have to pursue different and distinct areas of improvement each quarter. If Yes, Conduct a PC/CC practices assessment and utilize the results to pursue improvement during the remaining subsequent quarters where documentation of new improvement efforts can be provided. If No, Part Five: Documenting Quality Measures – Culture Change

45. Required DocumentationPC/CC Practices Improvement • Document showing NF pursued improvement in at least ONE area identified in the PC/CC Practices assessment as needing improvement • Must have done a PC/CC practices assessment to get points • Example: Assessment showed “home-like environment” was a significant issue. NF modified facility to create a more home-like environment by purchasing sofas, coffee tables, and chairs for central areas. • Must be during applicable time period • Create a pdf of a document showing how the NF pursued improvement based on the PC/CC practices assessment • Title the document “[facility name]12.pdf” Part Five: Documenting Quality Measures – Culture Change

46. Haven’t Assessed Culture Change/Person-Centered Practices? • Consider tools such as: • Artifacts of Culture Change • Culture Change Staging Tool (used by My Innerview) • Advancing Excellence in America’s Nursing Homes includes Person-Centered Care as an Organizational Goal. • Facilities can complete the Probing Questions identified under Examine Process • Please note that this is not an exhaustive listing of acceptable instruments, but directs facilities toward instruments that may be useful in their initial quality improvement efforts. Part Five: Documenting Quality Measures – Culture Change

47. Member/Resident & Family Input Did the facility have an active resident/family council or advisory committee between July 1, 2013 and June 30, 2014? ASK Submit proof of an active council or committee and receive five points for the current quarter and every subsequent quarter of the bridge year for this measure. Submit a copy of documentation and receive five points for every quarter of the bridge year for this measure. If Yes, Establish an active resident/family council or advisory committee during a subsequent quarter and receive points for the following quarters during the bridge year for this measure. If No, Part Five: Documenting Quality Measures – Culture Change

48. Required DocumentationResident/Family Council or Advisory Committee • Create a pdf of document proving the existence of an active council or committee • EX: Meeting schedule and meeting minutes or other meeting outcome documentation • Title the document “[facility name]13.pdf” • Need to know the number of active council/committee members, including whether member/resident or family. • Do NOT submit names or other identifying information Part Five: Documenting Quality Measures – Culture Change

49. If You Have Council/Committee… Did the facility receive input from the council/committee and use the input to address concerns or improve quality? ASK Submit documentation and receive five points for current quarter. Each subsequent quarter will require documentation of improvement effortsoccurring during that time period. If Yes, Establish a council/committee and utilize input to pursue improvement during the remaining subsequent quarters where documentation of new improvement efforts can be provided. If No, Part Five: Documenting Quality Measures – Culture Change

50. Required DocumentationMember/Resident & Family Input for Improvement • Create a pdf of a copy or description of the input received from council/committee • Include date of receipt • Title the document “[facility name]14.pdf” • Create a pdf document showing how the NF addressed input and pursued quality improvement. • Example: Resident council requested facility provide choice in meals. NF has begun providing at least two menu alternatives at each meal and can provide evidence/attestation that has occurred. • Must be during applicable time period • Title the document “[facility name]15.pdf” Part Five: Documenting Quality Measures – Culture Change