Ryan White Quality Management Steering Committee Meeting

1. Ryan White Quality Management Steering Committee Meeting Wednesday, February 17, 2010 Presenter: Katrina D. Gary

2. Welcome & Provider Updates

3. Purpose, Goals and Topics • Provide cross-parts with 2009 data analysis • Present measurement strategies for clinical indicators • Review Electronic Handbook

4. 2009 Accomplishments • Training Sessions • Provide Action Plan Training for all Part B medical case managers • New medical case manager training (June and December) • Fiscal management training • Provide Enterprise training for all RW providers (July and October) • Ryan White Institute (over 100 participants) • Provide Enterprise TA conference calls (a total of six calls) • Site Visits • 11 programmatic site visits including medical case management chart audits • 1 financial site visit in conjunction with DHEC’s Internal Audits • 17 data related site visits • 12 quality management site visits

5. 2009 Accomplishments • Managed the following Quality initiatives: • Quality Manager Certification • Development of quality TA manual • Data extraction from Part C providers via CAREWare • Revised SC RW Quality Management plan • Revised Part D providers’ Quality Management Plans • AIDS Drug Assistance Program (ADAP) • Transitioned over 2,500 patients from the old central pharmacy model to the current contracted pharmacy for direct dispensing. • Published revised program guidelines. • Rolled out the Prior Authorization process. • Held two CVS/Caremark – provider forums. • Piloted electronic insurance billing with Long’s • Submitted rebate reports and requests • Recertified over 2,500 patients • Processed an average of 100 applications per month • Managed contract and invoicing with drug wholesaler - Cardinal

6. 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.

7. 2010 Steering Committee Responsibilities • Strategic planning • Facilitating innovation and change • Providing guidance and reassurance • Allocating resources • Establishing a common culture

8. Getting Committee Work Done • Identify a chair for the committee • Set meeting frequency and duration • Document your progress • Establish communication channels • Train committee members on quality improvement

9. Providing Guidance and Reassurance • Oversees the progress of quality activities • Helps quality improvement teams in their work • Supports changes that result from quality improvement projects • Listens, observes, responds to staff concerns

10. Ways to Strengthen the HIV Quality Program • Convey the importance of quality to others • Organize educational activities to promote quality • Recognize staff for their quality improvement efforts • Institutionalize quality improvements • Demonstrate program successes

11. Convey the Importance of Quality to Others Create a quality "story board" in the waiting room, visible to both clients and staff Summarize quality data and show where improvements are needed Clarify the HIV quality activities to your parent organization’s leadership

12. Education Questions Did the appropriate people have the ability to participate in quality improvement training opportunities? Staff Consumers

13. Quality Management Food For Thought “By what method could new leaders bring improvement in living?”

14. Answer: You Do Three Things 1. Set the aim 2. Measure 3. Make changes

15. Act Plan Study Do Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement? Model for Improvement

16. Model for Improvement Aim statement contains: • Explicit description • Specific actions • Time specific • Measurable • Specific patients

17. Improvement Requires Action “While all changes do not lead to improvement,all improvement requires change.”

18. Tips for Measurement • Plot data over time • Use simple run charts (time series plots) of key measures directly related to your aim

19. Quality Improvement Activities are Supported by a Quality Infrastructure Infrastructure

20. HRSA HAB Stresses Five Elements Use a systematic process Establish benchmarks Be focused Be adaptable Seek improved outcomes

21. Looking at It Diagrammatically OUTPUTS: what your activities produce OUTCOMES: the results you expect from the outputs IMPACT: the long-term change you are seeking Measures Measures Measures

22. Most Quality Programs Will Focus on Output and Outcome Measures • Impact occurs over the long-term • Output and outcome measures give you information that is more useful for quality improvement

23. Key Points • The quality management infrastructure for non-clinical services follows the same format as that for clinical services • Use outputs, outcomes and impact as a framework for developing performance measures for services • Approach improvement using the Model for Improvement and PDSA cycles

24. Credits • National Quality Center • DHEC