2007 SHIP Directors’ Conference

1. Performance Assessment— A SHIP Management Tool Marilyn Maultsby, Director of SHIP Relations Pat Gongloff, SHIP Performance Assessment Office of External Affairs, Centers for Medicare & Medicaid Services June 13, 2007 2007 SHIP Directors’ Conference

2. Session Agenda • Purpose of Performance Assessment • Application of SHIP National Performance Reporting (NPR) Data to Performance Improvement • Application of NPR Data to Quality Improvement • NPR Systems Enhancements

3. Importance of Performance Assessment • Defines the goals and expectations of SHIPs in providing personalized assistance to beneficiaries • Gauges the availability and accessibility of personalized assistance to beneficiaries • Shows how resources were used and whether sufficient resources are available to SHIPs to perform their goals and objectives • Indicates where focus is needed to enhance overall SHIP performance

4. Uses of NPR • A reporting tool—to CMS and state governments • A management tool –for SHIP performance and quality improvement • A communication tool—to volunteers, staff, state legislatures, Congress, and potential funders (including federal, state, and foundations)

5. NPR – A Management Tool • A management tool to efficiently and effectively respond to beneficiary needs. For improvement in: • Program development • Volunteer recruitment, management and retention • Partnership development • Fund development • Quality of information and services

6. SHIP Performance Assessment Cycle • Basic Grant Application Reviews • National Performance Reporting (NPR) • SHIP Enrollment Data • Mystery Shopping • Periodic Surveys • SHIP Self Assessment • Internal/External Publications

7. Each SHIP is Unique…Yet,…

8. …There are Similarities • Receive CMS funding • Serve Medicare beneficiaries and those acting on their behalf through personalized counseling • Provide outreach • Use volunteers • Have local sponsors • Have local partners • Part of a larger state department

9. SHIP Expectations • Access to SHIP services provided to beneficiaries statewide • Access to SHIP services at the local level • Access to services by hard-to-reach populations, including low-income • One-on-one counseling to beneficiaries

10. SHIP Expectations • A well-trained workforce • Accurate and timely information provided to beneficiaries • State and local participation in CMS education and communication activities • Local partnership development

11. 2007 SHIP Performance Measures:Access to SHIP Services Statewide • The total number of Medicare beneficiaries in a state that were reached through one-on-one client contacts and in-person outreach, education, and enrollment group events per year per 1,000 beneficiaries in a State. • The total number of active SHIP counselor FTEs per 100,000 Medicare beneficiaries in a State.

12. 2007 SHIP Performance Measures: Access to SHIP Services at the Local Level • The total number of active SHIP local and field site counselor FTEs per 100,000 Medicare beneficiaries in a State. • The number of local partners integrally tied to the provision of SHIP counseling services by formal agreement such as a Counselor Agreement, Contract, or Memorandum of Understanding.

13. 2007 SHIP Performance Measures: Access to Services by Hard-to-Reach Populations • The percent of low-income beneficiaries reached of the total number of low-income beneficiaries in a State. • The percent of beneficiaries with a disability reached of the total number of beneficiaries with a disability in a State.

14. 2007 SHIP Performance Measures: One-on-One Counseling to Beneficiaries • The total number of Medicare beneficiaries in a State that were reached through one-on-one client contacts per year per 1,000 beneficiaries. • The total number of Medicare beneficiaries reached that discussed an enrollment, enrollment assistance, eligibility, benefits, and/or benefit comparisons topic under Medicare (Parts A and B), Medicare Health Plans, Medicare Prescription Drug Coverage, Medicaid, Medigap/Supplement/SELECT and Other: MyHealth topic per year per 1,000 beneficiaries in a State. • The total number of Medicare beneficiaries reached that discussed Medicare Prescription Drug enrollment assistance as a topic per year per 1,000 beneficiaries in a State.

15. 2007 SHIP Performance Measures: Accurate and Timely Information Provided to Beneficiaries • The percent of active SHIP counselors that participated in update trainings per year.

16. SHIP NPR Comparison Data • Variations by State • Completeness of data • Accuracy of data • Timeliness of time

17. Variations in the SHIP Network: Beneficiaries Reached Per 10,000 Beneficiaries in State

18. Variations in the SHIP Network: Local and Field Site Counselor FTEs Per 100,000 Beneficiaries in State

19. Variations in the SHIP Network: Total Counselor FTEs Per 100,000 Beneficiaries in State

20. Variations in the SHIP Network: One-on-One Client Contacts Per 10,000 Beneficiaries in State

21. To Account for Differences Across SHIPs… …2007 SHIP Grant Announcement Uses SHIP Clusters

22. Clusters to Account forDifferences Across SHIPs • Clustering – a way of grouping organizations with similar characteristics, to provide comparative data for the purposes of benchmarking, strategic planning, training, peer-to-peer networking, and recognitions • Clustering SHIPs may help account for the many differences among SHIPs by comparing similar SHIPs to one another as opposed to the network as a whole.

23. Clusters to Account forDifferences Across SHIPs • Size of Medicare population – the number of Medicare beneficiaries in a state, based on U.S. Census data • Density of the Medicare population – the number of beneficiaries per square mile in a state • Urban vs. rural areas – the percent of population in a Metropolitan Statistical Area (MSA)

24. SHIP Clusters by Size of Medicare Population and Density Cluster 1: Medicare population <500,000 and density <30 Cluster 2: Medicare population <500,000 and density >30 Cluster 3: Medicare population 500,000 to 1 million and density <30 Cluster 4: Medicare population 500,000 to 1 million and density >30 Cluster 5: Medicare population > 1 million and density <30 Cluster 6: Medicare population > 1 million and density >30

25. Example: SHIP Comparisons to National, Regional, and Cluster Medians for Beneficiaries Reached Per 10,000 Beneficiaries in State

29. How SHIPs Have Used Performance Data as a Management Tool • Program Development • Identified areas for allocation or re-allocation of resources • Compared performance within their State and discussed with staff and volunteers • Compared performance with other SHIPs and sought information on “best practices” • Supported accountability at the local sponsorship level • Identified activities for partner involvement

30. How SHIPs Have UsedPerformance Data as a Management Tool • Volunteer Recruitment, Management and Retention • Identified areas for counselor training • Public recognized and rewarded volunteers • Shared with counselors and coordinators the uses of NPR data by the SHIP to encourage their input of data • Fund Development • Report to their State governments and legislatures, for funding purposes • Become eligible for additional funding through CMS performance awards • Seek other funds

31. SHIP ranked above the cluster median for the number of beneficiaries reached in the State with improvements in 2005-2006 data vs. 2004-2005 data. Much of the difference between the two reporting periods was a result of inaccurate or lack of reporting. In 2004, while the event was included on the PAM Form, often, the number of people reached was left blank. In 2005 and 2006, accurate reporting was an emphasis in the program and will continue to be emphasized. How SHIPs Have Used Performance Data

32. SHIP ranked above the cluster median in each category. Has committed to a 10% improvement over the next 3 years. What SHIPs Plan to Do

33. SHIP is above the national median but below the cluster median for the period April ’05 – March ’06 for the number of active SHIP local and field site counselor FTEs per 100,000 Medicare beneficiaries in a State. Train and certify at least one Aging network staff at every senior center/elder center, and meal site statewide—an initiative that will prove to see a 20% increase in the number of field counselors. What SHIPs Plan to Do

34. SHIP Quality Improvement Efforts the SHIP will implement to assure that SHIP counselors are providing accurate, reliable, and unbiased information

35. SHIP Quality Improvement • Current SHIP performance measures don’t focus on quality • Opportunities: • National certification and re-certification of trainers and counselors • Web-based counselor certification tools, e.g. Iowa • Counselor and Beneficiary Satisfaction Surveys • Mystery Shopping Toolkit • Websites or other systems to provide updated information • Self-assessment Toolkit, e.g. Florida

36. What Your Peers Are Doing • Monitoring counselors is included in the duties of the sub-contractor. • Counselor certification/re-certification, surveys of beneficiaries to gauge satisfaction with counseling. • Counselors use the “buddy system” with experienced individuals and follow-up training throughout the year. • Expanded use of Internet training as a teaching tool.

37. What Your Peers Are Doing • SHIP offers at least four trainings throughout the year to counselors. • SHIP sends regular e-mails to coordinators and volunteers concerning information received from CMS. • SHIP has a private toll-free line for counselors to call the SHIP office with questions at any time during the regular working hours—avoids delays and waiting times on the SHIP consumer hotline, especially during high volume times.

38. SHIP Performance Assessment Requires • Consistent, complete, and timely submission of NPR data by all SHIPs: • Quarterly reporting for Client Contact Form and Public and Media Activity Form • Semi-annual reporting for Resource Report Form • Entering data into www.SHIPTalk.org directly or using state proprietary system file uploads

39. SHIP Performance Assessment Requires • Analysis of data • Providing standard and customized reports on www.SHIPtalk.org • Feedback to SHIPs and local sponsors for use as a management tool and development of action plans for performance and quality improvement

40. SHIP Performance Assessment Requires • Collaboration between SHIPs, the SHIP Steering Committee, SHIP Performance Assessment Workgroup, CMS Regional Offices,SHIP Resource Center, and others to: • Test on-going appropriateness of the performance measures • Monitor performance and quality improvement • Share information • Identification, implementation, and evaluation of targeted performance and quality improvement projects

41. NPR Systems Enhancements • Systems enhancements currently underway based on suggested changes from SHIPs • Customized reports for SHIPs • A User’s Manual • System navigation • System administration • Data input and editing processes • Trouble shooting report

42. NPR Systems Enhancements • Audiences • SHIP Directors • State IT departments • Local field coordinators and counselors

43. SHIP Performance Assessment Process • Building upon SHIP 2007 grant application program plans • In partnership with individual SHIPs, CMS Central and Regional Office Staff, the SHIP Resource Center and the SHIP Steering Committee: • Monitoring SHIP plans and performance • Assessing technical and programmatic needs • Planning and setting priorities

44. SHIP Performance Assessment Process • Convene a new SHIP Performance Assessment Workgroup • Participation from SHIP Steering Committee, other SHIP Directors, Academic & Research Community Experts, Partners • Review existing performance measures • Develop quality outcome measures • RFP process for NPR contractor • Transition period – August 15 – September 29 • New contract – September 29, 2007

45. Important Dates • NPR Data • Client Contact and PAM - July 30, 2007; October 31, 2007; January 31, 2008; April 30, 2008 • Resource Report – November 30, 2007; May 31, 2008 • Updated State performance packets • July 2007 • December 2007 (Grant Announcement) • Training on New NPR Systems Enhancements – July/August 2007 • 2007 SHIP Performance Awards – by September 30, 2007 • SHIP Mid-Term (Narrative) Reports – September 30, 2007