Leiza Johnson, BSN, RN NH Quality Improvement Specialist Mountain-Pacific Quality Health Alaska state hospital & nursing home association chief nurse executive meeting December 2017

Mountain-pacific quality health Serve as the Medicare Quality Innovation Network- Quality Improvement Organization (QIN-QIO) for Alaska Five offices: Alaska, Hawaii, Montana, Wyoming and Guam Contracted by the Centers for Medicare & Medicaid Services (CMS) to achieve the triple aim: 1) better care 2) better population health 3) lower costs We have expert staff who facilitate various quality improvement projects across the state

Role of the QIN-QIO Drive recognition of quality improvement Enhance quality of health care delivery Provide technical assistance Partnering with statewide stakeholders to align efforts Provide tools and resources Share best practices (learning & action networks)

OUR ALASKA TEAM IS… STRONG DIVERSE DYNAMIC EXPERIENCED

The Alaska team Sharon Scudder State Director, Alaska Preston Groogan Quality Reporting Leiza Johnson Nursing Home Task Lead Kyla Newland Adverse Drug Events Lori Chikoyak Antimicrobial Stewardship Coleman Cutchins Care Coodination QIN-QIO is Quality Innovation Network – Quality Improvement Organization CMS created QIOs essentially to help make sure their money is spent wisely. Role of QIN-QIO: CMS contracts with QINs across the US. Various contracts all with ‘triple aim’ of improving patient experience, reducing cost, decreasing HACs/improving clinical outcomes MPQH has task leads (in Alaska!) working on: Antimicrobial stewardship/CDI – across settings Diabetes self management Reducing readmissions Safe medication practices (ADEs, cardiac, diabetic) Role in reducing HACs – part of the contract is related to nursing home QI. Goals set by CMS are: 50% of collaborative will achieve composite of <6 Antipsychotic RIR Etc. ANHT collaborative – 100% commitment by all AK nursing homes. Etc etc Partners to support ANHTs: licensing & certification, ASHNHA, Alz Resource of AK, GWEP, ANTHC, Mental Health Trust, etc. Oh and I like to say we have a big state, little mascot…  * Leiza – began in QA in 1990’s – worked in Nome – came to Anch began to ‘specialize in JCAHO’ – went to school to get RN – worked in adolescent psych – full circle back to quality Miranda Burzinski Quality Reporting Cathy Colwell Diabetes Self-Management

Current Initiatives from CMS and Mountain-Pacific Staff Quality Reporting (Hospitals & Outpatient – QPP, MIPS, eCQI) Improving Coordination of Care Improving Antimicrobial Stewardship Reducing Disparities with Diabetes Miranda Burzinski Coleman Cutchins Lori Chikoyak Cathy Colwell Reducing Adverse Drug Events (ADEs) Improving Cardiac Health Improving Adult Immunization Rates Improving Long-Term Care Coleman Cutchins & Kyla Newland Kyla Newland Leiza Johnson

Reducing ADEs Screen patients in outpatient settings to prevent ADEs Track/ monitor ADEs Provide tools for ADE education Engage/ empower patients in their own care & medication management Three high-risk drug classes: Anticoagulants Opioids Diabetic agents

Leiza Johnson nursing home project Establish collaborative of nursing homes to work with the QIN-QIO on quality improvement initiatives In Alaska, this collaborative is called the “Alaska Nursing Homes Together,” or “ANHT,” group. CMS established goals for this work: Enrollment target: 35% of all Alaska nursing homes Composite score of <6 target: Rolling targets of 15%, 25%, 45% and 50% of nursing home partners achieving target by established dates (2016, 2017, 2018) Antipsychotic use reduction target: Reduction in rate (RIR) from baseline targets established of 3%, 9%, 15% and >15% each year (3% RIR by March 2016, etc.) Note: Alaska has failed this measure the past two quarters.

Project goals Exceeded Goal! Exceeded Goal!

antipsychotic reduction We are NOT meeting contract goal(s) – Root Cause Analysis to evaluate failure.

Defining the composite score Represents quality indicators selected to characterize nursing homes’ performance Includes 13 QMs, which are summed to get an overall composite score Data is pulled from nursing home’s Minimum Data Set (MDS) submission When setting QI targets, CMS recognized the best nursing homes had a composite score of <6, so this was established as the goal

Sample composite report state of Alaksa

State of Alaska QMs

Current status Alaska vs. Mountain-Pacific’s other states vs Current status Alaska vs. Mountain-Pacific’s other states vs. national rates Quality Measure Alaska Sept. Aug. Montana Wyoming Hawaii Nation 11/9/17 Antipsychotic Use 11.15 10.33 14.49 12.64 6.80 15.9 Incontinence 41.41 37.63 44.36 41.94 46.82 47.6 Late Loss ADLs 16.26 15.03 14.97 15.62 13.33 18.3 Pain 28.42 28.08 13.17 13.29 6.56 5.9 State Average 9.03 8.65 8.90 8.40 5.94 N/A Goal for all measures is <6. ANHTs have chosen Antipsychotic Use, Incontinence, Late Loss ADLs and Pain as QMs to focus on at the state level.

Questions? Leiza Johnson, BSN, RN Mountain-Pacific Quality Health ejohnson@mpqhf.org

Thank you for your time! Developed by Mountain-Pacific Quality Health, the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Montana, Wyoming, Alaska, Hawaii and the U.S. Pacific Territories of Guam and American Samoa and the Commonwealth of the Northern Mariana Islands, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-MPQHF-AK-C2-15-53