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LTSS Consumer Quality – Technical Workgroup

LTSS Consumer Quality – Technical Workgroup. May 22, 2014 (Updated) Gary Montrose & Jose Torres-Vega a nd Spark Policy Institute . Agenda. Review of LTSS tools used by state partners (from May 2, 2014 state presentations)

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LTSS Consumer Quality – Technical Workgroup

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  1. LTSS Consumer Quality – Technical Workgroup May 22, 2014 (Updated) Gary Montrose & Jose Torres-Vega and Spark Policy Institute

  2. Agenda Review of LTSS tools used by state partners (from May 2, 2014 state presentations) Debrief: Dr. Kaye’s presentation for Colorado relevance, opportunities Review: Cross walk update, utility for future consumer survey work Explore: Next steps and Scope of Recommendations

  3. Review & Debrief State Agency LTSS Tools

  4. State Agency Instruments Currently used

  5. Office of Behavioral Health: Data & Evaluation Unit • MHSIP/YSS-F/YSS (Mental Health Statistics Improvement Program/Youth Services Survey for Families/Youth Services Survey) • Currently piloted: ECHO+ • Two qualitative questions: • +/- aspects of behavioral health services received • 45+ quantitative questions • Access to services & general satisfaction • Participation in treatment planning • Quality of treatment (cultural sensitivity for youth clients) • Perceived outcomes • Social connectedness & functioning

  6. HCPF/Div. for Intellectual & Developmental Disabilities (DIDD) • NCI–DD Adult Consumer Survey • Currently implemented: First year for Colorado (40 states implement) • Qualitative face-to-face interview • Individual outcomes • Health, welfare and rights • System performance • Staff stability • Family outcomes • Quantitative • Demographic and basic medical data

  7. NCI framework comprised of four types of surveys • NCI-DD face to face • Three mail surveys • Adult Family Survey • Family Guardian Survey • Child Family Survey

  8. HCPF • MFP Quality of Life Survey • Qualitative method only (primarily phone interview) • Living Situation • Choice & Control • Access to Personal Care • Respect & Dignity • Community Integration & Inclusion • Satisfaction • Health Status • Case managers collect prior to transition from facility-based care & 11 and 24 months post-transition • Mathematica evaluator

  9. HCPF • CSS Waiver: client satisfaction survey • Qualitative: only in “additional comments” • Quantitative: • Yes/No questions, Likert Scale for overall satisfaction questions & demographics • Domains • Their Case Manager • Level of involvement and choice in services & providers • Availability of information and resources • Knowledge of how to file complaints • Quality of care received from caregivers • Online survey sent to SEP agencies that mail paper copy to clients

  10. HCPF • CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys for Adult and Child Medicaid (FFS and Managed Care) and CHP+ • Qualitative: member, self-reported (mail & phone) • Rating of all Health Care • Rating of Personal Doctor • Rating of Specialist Seen Most Often • Coordination of Care • Conducted by HSAG (EQRO) • Random sample • Annual consumer satisfaction survey

  11. State Agency Instruments Future Plans

  12. HCPF • TEFT (Testing Experience and Functional Tools in Community-Based Long Term Services and Supports • Planning & Demonstration grant funded • Test with Home & Community-Based Services for the Elderly, Blind & Disabled (HCBS-EBD) • HCBS for Supported Living Services • Random sample for each, large enough for statistical analysis • Truven contractor

  13. TEFT (continued) • Domains • Services and Supports from personal assistant and behavioral staff • Services and Supports from homemakers • Case Management • Choice • Transportation • Personal Safety • Community Inclusion and empowerment • Employment

  14. HCPF • NCI-AD (National Core Indicators – Aging and Disability) • Qualitative: face-to-face interviews • Service Satisfaction • Living Space • Safety/Security/Privacy • Community • Everyday living • Relationships • Healthcare • Planning for Future • Independence/Functional Competence • Direct Care Workers • Health Care Workers • Quantitative • Demographic & medical

  15. Overview and Debrief Dr. Kaye’s Presentation

  16. Why Measure LTSS QOL? • States transitioning to managed care • Quality measures help states’ commitment to providing quality services • Quality measures can focus on meeting people’s needs • Quality measures allow advocates to track outcomes • People’s lives are better if they can stay in the community rather than in the institutions

  17. Types of Measures • Structure: The system • Process: Provision of services by the system • Outcomes: Effect of services on consumer*

  18. LTSS Quality & Outcomes:CLPC Conceptual Framework QOL Domains • Paid/unpaid LTSS providers • Supportive Environment • Services & Supports Received • Consumer Outcomes

  19. Potential data sources • Program documents & administrators • scope, organization, accountability, etc. • Administrative records • expenditures, participation, settings, services received, complaints, workforce • Medical or claims records (encounter data) • health & functional status, utilization, prevention • National or state survey data • unmet LTSS need, workforce, caregiver support • Surveys of LTSS recipients • adequacy, appropriateness, consumer outcomes

  20. Available LTSS quality tools LTSS program characteristics • Survey instruments, e.g., • National Core Indicators • Developmental Disabilities • Aging & Physical Disabilities • HCBS Experience Survey • Participant Experience Survey • MFP Quality of Life Survey • Consumer outcome/QOL domains • PEONIES • Kane Quality of Life domains • CQL Personal Outcome Measures • Process & structure measures • Indicators LTSS Resources Paid & unpaid providers Supportive environment LTSS received The LTSS Consumer Consumer Outcomes LTSS system responsiveness

  21. Selecting quality & outcome measures • Clarify your purpose and keep it in mind • Stakeholder & consumer input is critical • Consider using existing measures, either as is or as a starting point for further development • Selecting or developing measures is generally a trade-off: • How relevant are the measures? • Can the results be used for comparison? • Are findings likely to influence policy? • How difficult is it to obtain the needed data? • Have the measures been tested for validity/reliability?

  22. Steps for Developing Questions • Creating a new instrument • Qualitative interviews to find out what’s important • Develop questions based on understanding which issues are important to the consumer • Cognitive testing of instrument • Pilot the survey/interview • Ask testers to comment on each response

  23. Steps for Selecting Existing Questions • Use the LTSS Question Library to identify potential questions within domains/sub-domains • Selection based on what is NOT currently captured through existing state data collection but is important to understand LTSS quality of life

  24. Review Crosswalk Update & Potential Future Survey Work

  25. Kaye’s Framework QOL Domains • Paid/unpaid LTSS providers • Supportive Environment • Services & Supports Received • Consumer Outcomes

  26. Kaye’s Domains & Subdomains Related to QOL 1. Paid & Unpaid LTSS Providers 2. Supportive Environment Accessibility and accommodations Technology Resources Settings • Caregiver/family support • Workforce development • Worker availability and quality

  27. 4. Consumer Outcomes Kayes’ Domains and Subdomains Related to QOL 3. Services and Supports Received Adequacy Appropriateness Coordination Utilization Health and Function Well-being Participation Safety

  28. Instruments Cross-walked by Kaye’s Domains/Subdomains State of Colorado Uses Nationally recognized instruments NCI Family Adult Intellectual and Developmental Disabilities (NCI-I/DD) CQL – Personal Outcomes Measures (POMS) CQL Basic Assurances Personal Experience Outcomes iNtegrated Interview and Evaluation (PEONIES) • National Core Indicators Adult Consumer (NCI- DD): Colorado implement for first time in 2014 • NCI Aging and Disability (NCI-AD): Colorado will pilot in 2015

  29. Kaye “Supportive Environment/ Resources” & POMS “My Self/Security and Continuity”

  30. POMS Detail

  31. Kaye “Supportive Environment/ Resources” & CQL Basic Assurances”

  32. CQL Detail

  33. Overview of the Crosswalk Results Draft Report

  34. Structure • Assesses NCI-DD and AD by Kaye domains/subdomains • Provides table in each section with • Advisory Committee input on Kaye subdomains • Potential questions derived from other instruments in the crosswalk • Serves as the technical report and basis for a library of questions by domains

  35. Explore Next Steps and Scope of Recommendations

  36. Proposed Consensus Recommendations Update the 2007 HCPF Quality Strategy from a Consumer Perspective Consumer-Agency Alignment Pursue R&D opportunities regarding “Add-on” questions to standardized surveys Maintain/grow an LTSS Question/Methods Library Pursue funding opportunities

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